Clinical question: 19-year-old with persistent left origin headaches compatible with migraine. A small percentage of these aneurysm. Check for aneurysm. She is a surgical candidate. Signs and symptoms: Persistent headache. Nonenhanced brain MRI:Normal appearing bilateral intracranial vertebral arteries, bilateral pica branches, basilar artery and its distal branches.Normal appearing right internal carotid artery, right anterior and middle cerebral arteries and their distal branches. Normal appearing small right posterior communicating artery is identified.Normal left internal carotid artery, normal left anterior cerebral artery and its branches. There is anatomical variation of both divisions of the left middle cerebral artery arising from the supraclinoid left internal carotid however without evidence of an aneurysm and with normal distal branches.
Unremarkable intracranial MRA.