69-year-old female with history of basilar tip aneurysm with new headaches. Brain w/wo: There is no evidence of intracranial hemorrhage or acute ischemic infarction. There is a chronic infarction within the left parietal/occipital region appearing similar to prior. There is extensive periventricular and subcortical white matter increased T2/FLAIR signal abnormality which is nonspecific. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The orbits are unremarkable.MRA: Redemonstrated is a 9 x 7 mm wide-necked basilar tip aneurysm. The neck of the aneurysm measures approximately 7 mm. The right PCA and right superior cerebellar artery arise from the aneurysm sac. Overall the aneurysm appears similar to the study from 10/2014. There is anterograde flow within the distal bilateral vertebral arteries, basilar artery, distal bilateral internal carotid arteries and carotid siphons as well as the anterior, middle, and posterior cerebral arteries. There is no evidence of arterial stenosis or occlusions.
1. Basilar tip aneurysm measuring 9 x 7 mm appearing relatively stable (within 10% of measurement differences) when compared to the MRA from 10/2014. In the setting of new development or changing of the nature of headache, active treatment options should be discussed with the patient. Either Neurosurgical or Neurointerventional clinic consultation is recommended.2. Unchanged nonspecific periventricular and subcortical increased T2/FLAIR signal abnormality which is nonspecific but may be related to XRT and/or chronic small vessel ischemic disease.3. Stable chronic infarction in the left parietal/occipital region.Findings and plan discussed with Brittany Beach by Dr. Masse at 0900 on 3/4/15.