Dx Status post embolization of right MCA aneurysm

she803

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I can't find ICD-9 code for Status post embolization of right middle cerebral artery aneurysm. I'm not sure to use 437.3 since it doesn't indicate rupture in this report...thanks again.

Examination: MRI of the brain and MRA of the head and neck without intravenous contrast material

History: Status post embolization of right MCA aneurysm. New onset weakness.

Technique: Multi sequence multiplanar MR of the brain without contrast was performed including sagittal T1, axial FLAIR, axial gradient echo T2, and diffusion weighted imaging with ADC map. 2-D time of flight MRA of the neck and 3-D time of flight MRA imaging of the head was performed without intravenous contrast material. Maximum intensity projections and multiplanar reformats were obtained. Comparison is made to a CT of the head from December 10, 2011 at 922 am.

Findings:
There are punctate foci of restricted diffusion in the right caudate head and right lentiform nucleus. There are also 2 additional punctate foci of restricted diffusion at the right occipital/temporal junction. Restricted diffusion is also seen in the high right posterior frontal cortex. Findings are consistent with acute infarctions. There is mild associated edema within the right caudate head, lentiform nucleus, and right frontal infarct. There are FLAIR/T2 subcortical and periventricular signal abnormalities consistent with microvascular ischemic change. There is a large endovascular coil mass in the right MCA cistern consistent with known prior embolization. There is a punctate focus of susceptibility artifact in the right corona radiata, either chronic micro hemorrhage or calcification. The ventricles are normal in size and configuration.

The MRA of the head is degraded by motion. The visualized vertebral arteries are normal .The basilar artery and its branches are normal. The posterior communicating arteries are normal.

The internal carotid arteries are normal. Beginning at the right middle cerebral artery bifurcation, there is decreased flow-related signal in the right M2 segments which may be due to slow flow or stenosis. There is normal flow-related signal in the distal middle cerebral artery branches. There is a 5 mm aneurysm arising off the right pericallosal artery, as seen on the prior study, directed anterolaterally. There is signal abnormality surrounding the right middle cerebral artery endovascular coil mass which is likely artifactual.

Evaluation of the neck is severely degraded by motion. There is no occlusion of the internal carotid, vertebral, and common carotid arteries.

Impression:
Multiple punctate foci of restricted diffusion in the right caudate, right lentiform nucleus, right occipitotemporal junction, and right posterior frontal cortex consistent with acute infarcts in the right middle cerebral artery territory.

Endovascular coil mass in the right middle cerebral artery cistern with associated artifact.

5 mm aneurysm arising from the right pericallosal artery as seen on the prior study

Decrease in flow related signal beginning at the right middle cerebral artery bifurcation extending into the M2 segments, which may be related to slow flow or stenosis.

MRA of the neck severely degraded by motion.
 
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