Clinical question: History of bilateral MCA aneurysm coiling 2005. Presents with headache and encephalopathy. Signs and symptoms: As above. Nonenhanced brain MRI:Negative diffusion weighted series.Examination demonstrates a well demarcated round extra axial lesion in convexity paramedian left posterior frontal measuring approximately 11 times 12-mm. It demonstrates isointense signal on T2 and T1-weighted images and abuts the inner table calvarium. Finding is highly suggestive of a small meningioma which demonstrate no change since prior head CT study from 3 -- 8 -- 15.Examination demonstrates findings suggestive of mild chronic small vessel scan is strokes evident by tiny foci of subcortical and periventricular flair/T2 hyperintensity of bilateral cerebral hemispheres. Minimal similar finding in the right basal ganglial is also noted. The signal intensity of brain parenchyma is otherwise within normal on all MRI sequences. Well-demarcated round foci of susceptibility representing previously coiled supraclinoid internal carotid artery aneurysms are identified.Prominence of cortical sulci for patient's stated age of 66 and remains similar to prior head CT examination. The signal void of major intracranial arterial branches are identified.Unremarkable images through the orbits, paranasal sinuses and mastoid air cells.
1.No acute intracranial process.2.Findings of mild age indeterminate small vessel ischemic strokes.3.High convexity left posterior frontal paramedian extra-axial meningioma (12 x 11-mm) without change since prior study.4.Susceptibility signal changes representing coiled bilateral supraclinoid internal carotid artery aneurysms.5.