How would you next image this patient?
This patient requires vascular imaging. In most institutions the next test would be non-invasive and either CT angiography or MR angiography. Catheter angiography, although usually required eventually, is usually a second step, at which time intervention can also be contemplated.
Non contrast CTB demonstrates a region of irregular density in the left temporal lobe, slightly hyperdense to adjacent white matter. A few flecks of calcification are seen within it.
The left internal carotid artery (ICA) and middle cerebral branches appear enlarged, and there is the suggestion of enlarged tubular structures over the surface of the temporal lobe.