Reason: Eval for berry aneurysm in patient with PCKD History: PCKD, headache, history of stroke in family MRI of the brainthere is a punctate focus of diffusion restriction present at the right inferior parietal lobule.There is a mild to moderate degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. Small lesions hyperintense on T2 and flair are present in the basal ganglia and left thalamus as well as the brainstem.The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.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 clear. 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 no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified and is medium-size paired there is triplication of the intercerebral artery. The posterior communicating arteries are very small. The vertebral arteries are similar in size.
1.An acute microinfarct is present in the right inferior parietal lobule.2.Small lesions in the thalami, basal ganglia and brainstem are suspected to represent lacunar infarcts.3.Periventricular and subcortical white matter changes of a mild to moderate degree are nonspecific. At this age they are most likely vascular related. No evidence for cerebrovascular occlusive disease.4.No evidence for intracranial aneurysm.5.No evidence for intracranial cerebrovascular occlusion.