73 years Female (DOB:10/10/1942)Reason: r/o stroke History: left facial tingling. Postural instability. Patient also endorses paresthesia over the dorsal aspect of the left hand, and the last two toes of the left foot, which she reports being common aurous phenomena. She denies headache, photophobia, nausea, or vomiting. Last migrainous attack was one month ago.PROVIDER/ATTENDING NAME: JAMES J WALTER JAMES J WALTER MRI of the brainNo diffusion weighted abnormalities are appreciated.The CSF spaces are appropriate for the patient's stated age with no midline shift. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is a 7 x 5 mm axial dimension aneurysm originating from the left half of the anterior communicating artery which is directed towards the right and the posteriorly. It appears multilobulatedThere is a 9 x 4 mm axial dimension aneurysm present originating from the distal right internal carotid artery at the origin of the right posterior cerebral artery which has a fetal origin.There is a 1.5 mm aneurysm present at the distal left internal carotid artery possibly the origin of the left anterior choroidal artery.The anterior communicating artery is identified and is medium size. The posterior communicating arteries are intact. The left vertebral artery is larger than the right vertebral artery. The left posterior inferior cerebellar artery is dominantMRA neck:There is opacification of the aortic arch, great vessels from the aortic arch and carotid arteries and vertebral arteries. There is no significant stenosis identified of the great vessels from the aortic arch. As a mild narrowing of the left subclavian artery at its origin and 40% stenosis of the left subclavian artery proximal to the left vertebral artery origin. There is On the basis of NASCET criteria there is no significant stenosis at the carotid bifurcations. There is no significant stenosis along the course of the left vertebral artery. The right vertebral artery is smaller than the left vertebral artery. There is 50% stenosis at the origin of the right vertebral artery.
1.Left sided 7 mm anterior communicating artery aneurysm2.9 mm right communicating segment aneurysm.3.An alphanumeric page was sent to Andrea Loggini at the time of this dictation to discuss the above findings given the reported history of migrainous headache attacks.4.There is approximately 50% stenosis at the origin of the right vertebral artery and mild atherosclerotic narrowing along the left subclavian artery. The right vertebral artery is smaller than the left vertebral artery.