Diagnosis: Aneurysm of unspecified siteClinical question: h/o MCA rupture as newbornSigns and Symptoms: surveillance; head tremor, ataxia MRI of the brainNo diffusion weighted abnormalities are appreciated.There is redemonstration of status post right-sided craniectomy. There is multiseptated cystic encephalomalacia present centered along the right parietal lobe but extending to the adjacent right temporal lobe. A component of this is cystic encephalomalacia protrudes through the craniectomy defect. There is associated ex vacuo effect along the right lateral ventricle. Since the prior exam the septations are somewhat more clearly demarcated and there is a dominant cyst within this multiseptated lesion measuring 45 x 35 mm axial dimensions. Some susceptibility effect is present within the lesion. As a punctate focus of low signal on susceptibility imaging within the right temporal lobe..A previously noted cystic lesion along the left superior frontal gyrus has involuted since the prior examVentriculostomy tube courses through the left parietal lobe into the trigone of the left lateral ventricle and has its tip crossing the midline. There is metal artifact present at centered at the left parietal calvarium which obscures visualization of portions of the left parietal and temporal lobes.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are underdeveloped. The visualized portions of the mastoid air cells are underdeveloped. The visualized portions of the orbits are intact.MRA brain: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 right A1 segment is larger than the left A1 segment. The anterior communicating artery is medium-sized. The posterior communicating arteries are identified. The right posterior communicating artery is small to medium sized whereas the left posterior communicating artery is medium-sized. The right vertebral artery is larger than the left vertebral artery.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.
1.No evidence for cerebrovascular occlusive disease.2.No evidence for intracranial aneurysm.3.There is cystic encephalomalacia centered in the right parietal lobe as detailed above which continues to evolve. This is likely related patient's prior infarction. It currently has a more organized appearance than on the prior exam. Part of the encephalomalacic brain protrudes into the craniectomy defect.