Findings:
Known, inferior type left MCA bifurcation aneurysm, measuring approximately 4 x 5 mm, unchanged to the previous study.
Hypoplastic right V4 segment is noted. The Circle of Willis is otherwise normal with conventional anatomy.
No intra- or extra-axial mass lesion or collection is identified. There is no mass or midline shift.
Prominent perivascular spaces are seen in bilateral cerebral hemispheres, more pronounced involving the basal ganglia, consistent with status cribrosum. Mild-to-moderate background small vessel ischaemic disease.
The brain parenchyma is otherwise unremarkable. No abnormal signal on the susceptibility-weighted images or diffusion/ADC images is identified.
Mucosal thickening is seen in the maxillary sinuses. Partial obliteration of the mastoid air cells is seen bilaterally. The orbits are unremarkable.
No bony abnormality is seen.
Conclusion:
Stable appearance of the left MCA bifurcation aneurysm.