Diagnosis: HeadacheClinical question: Evidence of intracranial pathologySigns and Symptoms: headache and intractable headache MRI of the brainNo diffusion weighted abnormalities are appreciated.The patient is status post suboccipital craniotomy likely for Chiari decompression. There is no obstruction at the level of foramen magnum.There are punctate foci of susceptibility effect along the periphery of the cerebellar hemispheres at the suboccipital craniectomy site.There are a couple subcortical punctate foci of T2 and FLAIR signal hyperintensity present along the left external capsule and left orbital gyrus. In isolation these are of little clinical significance..The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal 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 visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified and is medium size. There is triplication of the anterior cerebral artery present. The posterior communicating arteries are intact. The right posterior communicating artery is larger than the left posterior communicating artery. The left vertebral artery slightly larger than the right vertebral artery. The right anterior inferior cerebellar artery is dominant. The left posterior inferior cerebellar artery is dominant.MRV brain:The dural venous sinuses are patent. Straight sinus, internal cerebral veins and basal veins are identified and appear patent. The right transverse sinus, sigmoid sinus and jugular bulb are larger than the left-sided counterparts. The corresponding grooves and foramina are similarly smaller based on the recent CT of the head.Cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina.At C4-5 there is no significant compromise to the spinal canal or neural foramina.At C5-6 there is no significant compromise to the spinal canal or neural foramina.At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.
1.There is no evidence for acute cerebral infarction or intracranial mass lesion.2.Status post suboccipital craniotomy for Chiari decompression. There is no obstruction at the level of the foramen magnum.3.There are microhemorrhages present along the cerebellar hemispheres. These can only be visualized on susceptibility weighted sequences.4.There is no evidence for intracranial cerebral aneurysm5.There is no evidence for dural venous sinus occlusive disease.6.There is no evidence for spinal stenosis in the cervical spine.