Reason: eval sp occlusion of the R PCOMM, R anterior choroidal, and Lt ICA aneurysm History: cerebral aneurysm MRA: There is nodular enhancement of the aneurysmal wall with irregular shape compared to round appearance on prior exam, suggestive of shrinkage of left cavernous sinus segment giant aneurysm. Unchanged MR characteristics of local enhancement of adjacent dura. There is no brain parenchymal enhancement. The intra aneurysmal non thrombotic luminal enhancement of the left cavernous sinus segment aneurysm seen on prior scan is no longer seen, compatible with left ICA aneurysmal progressive thrombosis. Left anterior cerebral circulation is reconstituted by the right ICA via circle of Willis especially through the Acom artery. Right posterior communicating artery aneurysm was coiled without residual arterial flow and shows patent right PCom artery. Right anterior choroidal artery aneurysm has expected small residual lumen. Distal right ICA stent is patent without evidence of intimal hyperplasia. Stable ectatic and tortuous appearance of the vertebrobasilar system.MRI brain: No abnormal diffusion restriction. No acute intracranial hemorrhage. No ventriculomegaly. Cisterns are patent. No midline shift. There is stable right gyriform susceptibility artifact in the superior frontal sulcus, consistent with prior hemorrhage, unchanged. Scattered periventricular and subcortical white matter T2/FLAIR hyperintensities compatible with chronic small vessel ischemic disease. Scattered ethmoid air cell opacification. Partial opacification of the left mastoid air cells. Small left maxillary mucous retention cyst. Orbits are intact.
1.Thrombosing left cavernous sinus aneurysm status post left ICA endovascular occlusion. Stable adjacent dura and aneurysmal wall enhancement without parenchymal enhancement.2.Status post coiling of the right posterior communicating artery aneurysm without recannulization.3.Status post coiling of the right anterior choroidal artery aneurysm with expected residual arterial flow.4.Stented right distal ICA is patent without restenosis.5.No acute intracranial hemorrhage, no new acute ischemic lesion.