Case Notes
History
47 yo female who presents with right sided acute weakness. Hx: cocaine abuse and an unruptured right MCA aneurysm.Exam
Noncontrast T1-w MR
Prior Study
Noncontrast CT headGiven the history of cocaine abuse and hypertension, there is substantial global brain atrophy for chronological age, plus end-artery type of completed lacunar infarctions.
MRA of the neck
Normal MRA of the neck without vascular stenoses nor dissection.
MRA of the head
Right MCA bifurcation saccular aneurysm, as above.
Suspicious evidence of distal left MCA and PCA vasospasm plus minimal delay in filling rate, which are consistent with cocaine related distal arterial vasospasm. Otherwise, negative head MRA for arterial occlusion or dissection