Diagnostic Studies
Because the clinic visit revealed no acute red flags or ominous signs indicating a mass lesion or other significant abnormality, and the physical examination was nonfocal, the MRI was obtained about 5 weeks later. MRI findings included "… in the region of the left internal carotid artery (ICA) terminus, there were several locations suspicious for the possibility of aneurysm. There was no evidence of hemorrhage." The radiologist recommended obtaining magnetic resonance angiography (MRA), which was performed 4 days later. MRA revealed a markedly tortuous and medially coursing supraclinoid and distal cavernous left internal carotid artery (ICA) and enlarged caliber of the left ICA, which was suspicious for fusiform aneurysmal dilation. A saccular aneurysm was also found at the left ICA terminus.