Right-sided pulsatile tinnitus. Brain:There is no evidence of acute infarct or intracranial hemorrhage. There is a 12 mm T2/FLAIR-hyperintense lesion involving the deep right parietal white-matter which is nonspecific and may reflect sequela of previous ischemia or inflammation/infection. Smaller T2/FLAIR-hyperintense lesions are present in the periventricular frontal white-matter and most probably reflect mild chronic microvascular ischemia. There is no midline shift or brain herniation.There is trace mucosal thickening in the paranasal sinuses. The skull is mildly diffusely thickened but without a focal lesion. There is a partially empty sella which is incidentally noted and a normal variant.While this study is not optimized for internal auditory canal assessment, there is no obvious mass in the cerebellopontine angles or internal auditory canals. There is also no gross vascular abnormality in the region.Cranial MRA:There is no flow-limiting intracranial arterial stenosis or aneurysm. Partially azygos A2 segments incidentally noted which is a normal variant. The posterior cerebral arteries are fetal-type in origin, which is also a common normal variation. There is an symmetric venous structure in the region of the right condylar canal which drains into the internal jugular vein. It has a flow-related signal that is higher than the adjacent right transverse sinus/internal jugular vein but lower than the arteries. This is of uncertain significance but may reflect an early draining vein if there is an underlying arteriovenous fistula.
1.There is no acute infarct or intracranial hemorrhage. Mild changes of chronic microvascular ischemia.2.Right parietal white-matter lesion is nonspecific but may reflect sequela of previous ischemia or infection/inflammation. 3.There is an asymmetrically prominent emissary vein in the region of the right condylar canal draining into the jugular vein as described above. This finding is of uncertain significance but raises possibility of early draining vein in the setting of a dural arteriovenous fistula. 