Patient History
Right visual field disturbances.
Findings
Study demonstrates an approximately 3cm (TRV) x 3cm (CC) x 2.4cm (AP) aneurysm that appears to be arising from the right carotid terminus. The aneurysm is associated with pulsation artifact which is most prominent contrast-enhanced T1 weighted images. The aneurysm is extending into the suprasellar cistern and abutting the optic chiasm. The aneurysm superiorly displaces the subfrontal region and thalamus with mass effect involving the 3rd ventricle. The aneurysm is also abutting and displacing the optic chiasm.
Axial FLAIR and T2-weighted images show marked prominence of the sulci and ventricles. There are multiple focal and confluent areas of increased FLAIR and T2 signal involving the juxtacortical, centrum semiovale and periventricular white matter, which is likely due to microvascular angiopathy. Contrast-enhanced T1-weighted images show no abnormal intra-axial enhancing masses.
Patient has undergone a right frontoparietal craniotomy.
Conclusions
1. 3cm x 3cm x 2.4cm aneurysm that appears to be arising from the right carotid terminus with mass effect on the adjacent brain and optic chiasm, which can be further characterized with MRA of the circle of Willis.
2. Marked prominence of the sulci and ventricles with increased FLAIR and T2 white matter changes likely due to microvascular angiopathy.
3. Remote right frontoparietal craniotomy.
