55-year-old female with hx of aneurysm clipping, 1yr follow up There is redemonstration of postsurgical changes consistent with right pterional craniotomy. Parasellar and intrahemispheric susceptibility artifact from aneurysm coil/clipping material is demonstrated. There is diffuse prominence of the cortical sulci in proportion to the cerebral ventricles consistent with diffuse cerebral atrophy. T2/FLAIR abnormalities involving the right frontal lobe, right frontal and temporal operculum, occipital lobe and right inferior parietal lobule are seen consistent with chronic infarction. Additional small lacunar infarcts are demonstrated in the right centrum semiovale. Subtle T2/FLAIR abnormality involving the left frontal lobe white matter may be related to chronic microvascular ischemic change. There is no evidence for diffusion restriction to suggest acute or subacute ischemia. No intra-axial or extra-axial fluid collections are visualized. No midline shift or mass effect is appreciated. There is no abnormal postcontrast enhancement demonstrated.The visualized paranasal sinuses and mastoid air cells are negative for fluid collections. The visualized orbits appear grossly unremarkable.3-D time-of-flight MRA demonstrates suspicious small (about 2mm) filling of the bottom of coil mass of the right Pcom aneurysm indicating possible minimal aneurysm recanalization. However, this could represent tortuous nature of the proximal right fetal PCA. Comparing to prior MRA (Apr-5 2015) this lesions appears to be slightly prominent.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. The bilateral internal carotid arteries and middle cerebral arteries demonstrate normal caliber without evidence for aneurysm. Susceptibility artifact from coiling material involving the Acom artery limits evaluation of the bilateral A1 and A2 segments. However, no new aneurysm is visualized. Fetal origins of the bilateral posterior cerebral arteries are again visualized.
1. Tortuosity of the right fetal PCA vs possible minimal aneurysm neck recanalization of previously coiled right Pcom aneurysm as described above.2. Postsurgical changes consistent with left frontal craniotomy and Acom aneurysm clipping as well as right P-comm aneurysm coiling are again seen. Susceptibility artifact limits evaluation of the surrounding vasculature.3. No evidence of new intracranial arterial aneurysm.4. Chronic infarction of the right frontal and parietal lobes is again seen.