Neuro_MR_Brain: 18 M, AMS and L MCA syndrome.

1. Findings most compatible with giant aneurysm of the dominant inferior division left M2 measuring 1.8 x 1.6 x 1.5 cm, with prior rupture and subsequent thrombosis. Absent flow-related signal in inferior division MCA distal to thrombosis, with large evolving infarct with cortical petechial hemorrhage. Few additional small bilateral ACA territory acute infarcts and left hippocampal infarct.

2. Stable to mild increase in mass effect due to combination of vasogenic edema from large left MCA territory infarct and mass effect and vasogenic edema associated with left temporal and insular intraparenchymal hemorrhage, with uncal herniation, compression of the brainstem and 8 to 9 mm of midline shift.

3. Narrowing of the left A1 and M1 segments, in part due to compression, component of early vasospasm is difficult to exclude.

(Ruptured giant aneurysm/abscess)