Clinical question: CVA. Signs and symptoms: Blindness. CTA of intracranial circulation:65 cc of Omnipaque 350 is administered for this study.Source images as well as 2-D reformatted images and 3-D reformatted images were utilized for interpretation of this exam.Vertebral -- basilar system:Vertebrobasilar system demonstrate patent bilateral vertebral arteries, bilateral pica branches, basilar artery, bilateral superior cerebellar arteries and posterior cerebral arteries with no evidence of vascular abnormality.Left internal carotid:Patent normal-appearing left internal carotid artery across the skull base. Patent left cavernous carotid however with vascular calcification. The left anterior and middle cerebral arteries and their branches are unremarkable.Right internal carotid: There is patent right internal carotid artery across the skull base and in its supraclinoid portion. There is an infundibulum shaped vascular outpouching at the expected location of right posterior communicating artery. The reformatted images demonstrate no posterior communicating artery at this site. However on source images a very minute right posterior communicating artery is identified. Although this finding may represent an infundibulum possibility of an aneurysm cannot be entirely ruled out. This finding measures 3.5 -mm at its base and 3.5-mm in height. The right anterior and middle cerebral arteries and their branches are unremarkable.CTA of the neck:No additional contrast was given for this portion of the exam.There is normal appearing bilateral vertebral arteries and including their origins.Right common carotid artery and including its origin is within normal limits. Very minimal atherosclerotic irregularity at the origin of the right internal carotid artery is noted. No vascular lumen compromise. The left common carotid artery and left internal carotid arteries are widely patent. Very minimal atherosclerotic irregularity at the origin of left internal carotid artery is however noted.Non-infused head CT:There is no evidence of intracranial hemorrhage, edema, mass-effect, midline shift or hydrocephalus. As noted on MRI there is fullness of the left cavernous sinus and left Meckel's cave and a small soft tissue density immediately medial to the left anterior clinoid as detailed on MRI report.
1.CTA of intracranial circulation demonstrates very minute atherosclerotic irregularity at the origin of bilateral internal carotid arteries and the otherwise negative CTA of vasculature of the neck.2.CTA of intracranial circulation demonstrates an infundibulum at the expected origin of the right posterior communicating artery. There is a very minute size posterior communicating artery on this side. Although this finding likely represent an infundibulum possibility of an aneurysm cannot be entirely ruled out considering the very small size of right posterior communicating artery. CTA of intracranial circulation is otherwise unremarkable. 3.Nonenhanced head CT is negative for any acute intracranial findings. Please review report of MRI examination regarding the mass at the level of left anterior clinoid and mass within the left cavernous sinus/Meckel's cave.