Headache. There are unchanged low-lying cerebellar tonsils, right more than left, with associated pointed morphologies. There is unchanged asymmetric enlargement of the left Meckel's cave, which measures up to 10 mm in width. There is a partially-empty sella. There is prominence of the bilateral optic nerve sheaths and flattening of the optic nerve heads. There is no evidence of intracranial hemorrhage or acute infarct. There is unchanged protrusion of the right posterior cingulate gyrus across the right tentorial leaflet. There is also protrusion of a portion of the inferior right temporal gyrus into an arachnoid granulation along the right transverse sinus. In addition, the bilateral transverses sinuses appear to be constricted. There is minimal nonspecific white matter T2 hyperintensity. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift.
Unchanged enlargement of the left Meckel's cave, low-lying cerebellar tonsils, partially-empty sella, as well as optic nerve sheath prominence. The constellation of findings may indicate pseudotumor cerebri perhaps superimposed upon Chiari I malformation. 