Forthcoming odontoid procedure, apnea, possible venous sinus thrombosis There is localized restricted diffusion on the right front lobe alongside with interhemispheric fissure without evidence of hemorrhagic transformation. This lesion may represent acute ischemic infarction likely embolic in nature.No evidence of hemorrhagic lesion on the scan.There is a 27 mm x 11 mm sized fluid collection on the right high frontoparietal area scalp, no change of its size since prior CT scan.There is no evidence of venous congestive encephalopathy.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. The paranasal sinuses and mastoid air cells are clear.3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate normal ICAs, MCAs and ACAs. Vertebrobasilar system appears to be normal. Left PCAs fetal origin.2D brain noncontrast enhanced MRV with maximum intensity projections of the superficial/deep intracranial venous drainage demonstrate normal craniofugal flow related enhancement in the superior sagittal sinus, transverse sinuses, sigmoid sinuses, internal cerebral veins, vein of Galen and straight sinus. These findings indicate venous blood flow within the major dural sinuses has been maintained. Multifocal signal drops on the distal superior sagittal sinus and proximal left transverse sinus as well as bilateral proximal internal jugular vein are likely to be artifactual considering no evidence of associated venous congestive encephalopathy. However, the diameter of distal superior sagittal sinus as well as bilateral transverse sigmoid sinuses appear to be a bit larger and than normal, these findings could represent mild to dural sinus malformation with maintaining cranial fugal flow. Therefore, follow-up imaging including brain MRI about 3-6 months is later can be considered.
1. Restricted diffusion on the right frontal lobe as described above indicating possible acute ischemic stroke. No evidence of hemorrhagic lesion.2. Normal brain MRA3. Ectatic venous sinuses with demonstration of craniofugal venous flow without evidence of congestive venous encephalopathy. No evidence of venous sinus thrombosis.4. Follow up brain MRI can be considered since the diameter of dural sinuses appears to be a bit larger than normal, thus possibility of mild dural sinus malformation may need to be excluded. 