 MRI BRAIN:There is no restricted diffusion to suggest acute infarct. Evidence of prior right frontal ventriculostomy catheter noted. Minimal intraventricular blood products. There are multiple T2/FLAIR hyperintense foci in the subcortical and periventricular white matter compatible with mild-to-moderate chronic small vessel ischemic changes. There is no midline shift. The ventricular size is stable. There is no abnormal enhancement. There is extensive susceptibility effect along the surface of the brainstem, cerebellum, and along the basal cisterns and sulci consistent with superficial siderosis related to prior subarachnoid hemorrhage.Perfusion images demonstrates prolonged mean transit time in the right anterior cerebral hemisphere.MRA BRAIN:The MRA is degraded by motion artifacts.There is nonfilling of the previously coiled aneurysm in the right P-comm artery.There is mild narrowing of the bilateral cavernous segments of the internal carotid arteries, right worse than the left, without flow-limiting stenosis. The right A1 is diminutive. Otherwise there is no flow-limiting stenosis in the intracranial circulation.
1. No evidence of acute infarct or intracranial mass effect.2. Diffuse superficial siderosis consistent with history of subarachnoid hemorrhage.3. There is mild narrowing of the bilateral cavernous internal carotid arteries, right worse than the left, without flow-limiting stenosis. The right A1 is diminutive, which may be related to hypoplasia with superimposed stenosis. Otherwise there is no flow-limiting stenosis in the intracranial circulation. The perfusion images demonstrate prolonged mean transit time in the right anterior cerebral hemisphere. This finding may be related to be the mild cavernous right internal carotid stenosis and diminutive right A1 segment; however consider vascular imaging of the neck to exclude higher grade proximal right carotid stenosis. MRA otherwise demonstrates no flow-limiting stenosis in the intracranial situation.4. Nonfilling of the previously coiled aneurysm in the right P-comm.