Female, 37 years old, with past medical history of cerebral venous thrombosis, originally diagnosed in 2000, not currently on anticoagulation, presenting with progressive headache. No evidence of restricted diffusion is seen. No significant parenchymal edema or mass effect is detected. Mild asymmetric T2 hyperintensity within the left ventral pons was present on the prior examination from 2011 and shows no significant interval change.No evidence of intracranial hemorrhage or any abnormal extra-axial fluid collection is seen. The ventricular system is normal in size and morphology. Cerebellar tonsillar ectopia is noted, a stable finding.On dedicated MRV imaging, the superior sagittal sinus is of small caliber and not well visualized at its anterior-most extent. The left transverse sinus is not well visualized, and the right shows at least one area of focal caliber change. Collateral venous vessels are evident along both transverse sinuses. The deep cerebral venous system, feeding into the vein of Galen and straight sinus, is prominent. Accounting for differences in scan technique, and for differences between MRV and CTV, no significant or convincing interval change is observed.
1.No acute intracranial abnormality is suspected.2.MRV imaging demonstrates chronic narrowing of the superior sagittal sinus and transverse sinuses, left more than right, with compensatory engorgement of the deep venous system. This could very well represent the chronic sequelae of prior venous sinus thrombosis or stenosis, but no convincing or significant interval change is appreciated when compared to multiple prior exams.