42 years Female (DOB:7/2/1974)Reason: s/p sinus surgery, now with headaches, eval for sinus disease History: HA worse at night, with associated nauseaPROVIDER/ATTENDING NAME: JAYANT M. PINTO JAYANT M. PINTO The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The cerebellar tonsils extend 1 mm below the level of foramen magnum.The visualized portions of the paranasal sinuses demonstrate mild mucosal thickening and status post antrectomies bilaterally and partial exenteration of ethmoid air cells.. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.
The patient is status post paranasal sinus surgery. There is no paranasal sinus outlet obstruction present. There is some mild mucosal thickening in the maxillary sinuses.Please note this is a limited exam for the purpose of treatment guidance.