52 years Female (DOB:7/5/1964)Reason: 3T scanner; hx of stenosis, ICH, aneurysm History: SeizuresPROVIDER/ATTENDING NAME: ISSAM A. AWAD ISSAM A. AWAD MRI of the brainThe patient is status post left temporal and parietal craniotomy. There is encephalomalacia present involving the left inferior parietal lobule and left superior temporal lobe. There surgical clips present centered within the focus of encephalomalacia. The patient is status post surgery and embolization for aneurysm in this location.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 demonstrate mild mucosal thickening. The visualized portions of the mastoid air cells are clear. 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.There is a tiny left superior hypophyseal aneurysm present which appears stable compared to prior exams. It measures approximately 1.5 x 3 mm in size.There is apparent narrowing of the proximal left M1 segment associated with less opacification of the left middle cerebral artery vasculature relative to the right side.The anterior communicating artery is identified. The posterior communicating arteries are small. The right posterior communicating artery is a small infundibulum associated with it. The vertebral arteries are similar in size.
1.Status post surgery and embolization for a left middle cerebral artery distal fusiform aneurysm. There is encephalomalacia present in the left supratemporal and the left inferior parietal lobule. These findings are stable2.Findings suggest but do not confirm 50% narrowing at the proximal left M1 segment and slower flow in the left middle cerebral artery territory than the right. Please correlate with clinical history. If appropriate, CTA may help further evaluate this.3.Stable small left superior hypophyseal aneurysm.