Clinical question: Unremitting headache. History of fracture 5 deficiency, on chronic anticoagulation. Signs and symptoms: Unremitting headaches and prolonged nasal congestion. Pre-and post-enhanced brain MRI:No diffusion weighted abnormalities.Examination re-demonstrates a very small focus of cortical and subcortical encephalomalacia in the left inferior frontal lobe without enhancement or interval change since prior exam. This finding is best appreciated on coronal T2-weighted series 601 on images 8 through 11 similar to prior exam.Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and brain myelination otherwise and without change.The signal void of major intracranial arterial branches are identified.The signal intensity of intracranial venous sinuses are within normal and with normal pattern of enhancement.Negative post infused images or abnormal parenchymal, leptomeningeal, calvarial, soft tissues of the scalp or the retro orbital enhancement.All paranasal sinuses and bilateral mastoid air cells are well pneumatized. Mild mucosal thickening of left maxillary sinus however is noted and is new since prior exam.
1.Negative diffusion weighted images.2.Stable small focus of cortical and subcortical encephalomalacia in the left inferior frontal lobe.3.Unremarkable pre-and post enhanced brain MRI otherwise and stable since prior study.4.Mild maxillary mucosal thickening is a new finding since prior study.