Diagnosis: Other symptoms and signs involving the musculoskeletal systemClinical question: Evaluate for venous sinus thrombosisSigns and Symptoms: Acute onset L sided weakness, headache MRI of the brainNo diffusion weighted abnormalities are appreciated.The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate mucosal thickening. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.At the clinoidal segment of the right internal carotid artery there is a medially directed 3 mm broad-based aneurysm.There is no evidence for intracranial cerebrovascular occlusion.The anterior communicating artery is identified. The posterior communicating arteries are not readily identified. The vertebral arteries are similar in size.MRV brain:The dural venous sinuses are patent. Straight sinus, internal cerebral veins and basal veins are identified and appear patent. The left transverse sinus and left sigmoid sinus are larger than the right-sided counterparts.
1.No evidence for cerebrovascular occlusive disease.2.There is a right internal carotid artery clinoid segment 3 mm aneurysm present3.MR venogram of the brain is within normal limits.4.There is no evidence for acute ischemic cerebral infarction.5.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related. 