 There is an abnormal appearance of the flow void within the distal right vertebral artery. Additionally, there is a small aneurysm focus of enhancement measuring 4 x 4 mm (series 24, image 70) at the bifurcation of the right middle cerebral artery.The olfactory groove and bulbs are symmetric without evidence of a mass or abnormal enhancement. No evidence of abnormal enhancement or a mass along the course of olfactory nerves bilaterally.There are no intracranial mass, mass effect, or midline shift. No evidence of intracranial hemorrhage or diffusion weighted abnormalities. No extra-axial fluid collections or subdural hematomas. Mild to moderate periventricular and subcortical white matter FLAIR/T2 signal abnormality consistent with chronic small vessel ischemic disease. The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. Small left maxillary retention cyst as well as two subcentimeter postinflammatory cysts in the nasopharynx. Otherwise, paranasal sinuses and mastoid air cells are clear. There is no abnormal enhancement within the brain.
1.There is an abnormal appearance of the flow void within the distal right vertebral artery.2.Small presumed 4 x 4 mm aneurysm at the bifurcation of right middle cerebral artery.3.Further evaluation with CTA of the head and neck is recommended further characterization of items 1 and 2.4.No evidence of mass along the olfactory groove, bulbs, or the expected location of the nerves as clinically questioned.Findings relayed to Susan Curtis, RN, telephonically at approximately 10:00 am on 2/20/2015.