Carotid-cavernous fistula, possibly related to the apparent small cavernous ICA aneurysm. Headaches. MRI BRAIN: There are a few scattered foci of T2 hyperintensity in the periventricular and subcortical white matter bilaterally. There is no evidence of acute ischemia or acute intracranial hemorrhage. There is no midline shift or mass effect. There is mild diffuse cerebral volume loss. There is an approximately 6 mm thick lipoma in the right parietal scalp. There is mild scattered paranasal sinus mucosal thickening. There are small retention or Thornwaldt cysts in the nasopharynx. The orbits are unremarkable. The skull appears to be intact. MRA BRAIN: There is a wide-based outpouching involving the lateral wall of the left cavernous internal carotid artery with neck that measures up to approximately 3 mm. The cavernous sinuses do not appear distended and there are no grossly abnormal flow voids or arterialized flow within the sinus. The right internal carotid artery appears unremarkable. The anterior and middle cerebral arteries are intact. The posterior cerebral arteries, vertebral arteries, and basilar artery are unremarkable. Indeed, there is no evidence of significant steno-occlusive cerebrovascular lesions.
1. A laterally oriented left cavernous internal carotid artery aneurysm measures up to approximately 3 mm.2. No specific findings to suggest a carotid-cavernous fistula. However, a dynamic cerebrovascular imaging examination may be more sensitive for detecting that condition.3. A few scattered foci of T2 hyperintensity in the subcortical and periventricular white matter are nonspecific, but may represent chronic small vessel ischemic disease. Otherwise, no evidence of acute infarction.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.