Reason: assess for ischemia, aneurysm change, hemorrhage History: sudden headache, h/x of left MCA aneurysm. BRAIN: The ventricles and sulci are within normal limits. The basal cisterns remain patent. There is no midline shift or mass effect. Scattered punctate and confluent foci of increased T2/FLAIR signal within the periventricular and subcortical white matter are nonspecific but compatible with moderate chronic small vessel ischemic changes and appear similar to prior. There are no areas of pathological enhancement. There is no diffusion abnormality. No extra-axial fluid collection is identified. Normal flow-voids are demonstrated in the major intracranial vascular structures. A partially empty sella is again incidentally noted. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.MRA HEAD: Images are mildly degraded by motion which limits assessment of small aneurysms. The intracranial internal carotid arteries are normal in course and caliber. There is redemonstration of an inferiorly directed saccular aneurysm measuring approximately 4 x 3 mm (trav x cranoicuadal) at the right MCA distal M1 segment appearing grossly unchanged. The middle and anterior cerebral arteries are otherwise unremarkable. A left P-comm is not definitively visualized. The vertebral arteries, basilar artery, and posterior cerebral arteries are normal in course and caliber. There is no evidence of flow-limiting stenosis or new aneurysm.
1.No evidence of acute infarction.2.Moderate chronic small vessel ischemic changes.3.MRA mildly limited by motion. Right MCA distal M1-MCA bifurcation 4 mm aneurysm, grossly unchanged.4.Partially empty sella which is nonspecific but can be seen with intracranial hypertension in the appropriate clinical setting.