Clinical question: Left hand numbness and left facial droop. Signs and symptoms: Concern for stroke, history of aneurysm. Nonenhanced brain MRI:No diffusion-weighted abnormalities.No convincing evidence of intracranial hemorrhage however if clinical concern for subarachnoid hemorrhage is high follow-up with head CT is recommended.The cerebral cortex, cortical sulci, ventricular system, CSF spaces and brain myelination demonstrate normal signal intensity on all MRI sequences and without interval change since prior exam. Ventricular systems remain within normal and mid maintained midline.The signal void of major intracranial arterial branches are identified.Unremarkable images through the orbits. Mild chronic sinusitis mostly in the ethmoid are noted.Nonenhanced brain MRA:All major intracranial arteries and their branches remain patent and stable since prior exam. There is revisualization of a stable small focus of vascular prominence at the origin of left posterior communicating artery measuring maximum of 2.5 mm in size compared to prior study measurement of 2 mm. The finding could represent an aneurysm or an infundibulum at the origin of left posterior communicating artery.Enhanced neck MRA:The visualized aortic arch and the origin is a major vessels are unremarkable.Unremarkable bilateral vertebral arteries and their origins.Right carotid demonstrate a well-demarcated atherosclerotic plaque at the origin of the right internal carotid without hemodynamically significant stenosis.Unremarkable left common and internal carotid arteries.Unremarkable bilateral external carotid arteries.
1.Nonenhanced brain MRI demonstrate no detectable acute intracranial process. Stable and unremarkable exam otherwise.2.Nonenhanced brain MRA demonstrate no evidence of vascular lumen compromise or stenosis. Focus of vascular prominence at the origin of the left posterior communicating artery representing an infundibulum or an aneurysm is again noted. It measures 2.5 mm compared to prior study measurement of 2 mm. This minimal difference is likely technique related however less likely possibility of true interval increased size cannot be completely excluded.3.Enhanced neck MRA demonstrates a small well-demarcated smooth atherosclerotic plaque at the origin of right internal carotid artery without hemodynamically significant stenosis and unremarkable otherwise.