Diagnosis: Tension-type headache, unspecified, not intractableClinical question: Eval for structural lesionsSigns and Symptoms: trauma and headaches MRI brain: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.Lumbar spine:Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact. There appears to be a transitional vertebra. Assuming that the L1-2 disc spaces at the level of the left renal vein this transitional vertebra would represent partial lumbarization of S1.At S1-S2 there is no significant compromise to spinal canal or neural foramina.At L5-S1 there is no significant compromise to spinal canal or neural foramina.At L4-5 there is no significant compromise to spinal canal or neural foramina.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.There is heterogeneous signal present along the right sacral alla which is incompletely assessed on this exam. It is bright on T2-weighted imaging and dark on T1. This suggests possible edema
1.No stigmata of intracranial traumatic brain injury are appreciated. MRI of the brain is within normal limits.2.There is no significant compromise to lumbar spinal canal or exiting nerve roots. There are no stigmata of trauma to the lumbar spine appreciated. There are minimal degenerative changes present in the lumbar spine. Please note that findings suggest a transitional vertebra which was labeled S1 for the purpose of this exam. This may confound enumeration of lumbar vertebrae.3.There is heterogeneous signal present along the right sacral Alla. It is incompletely evaluated on this exam. Additional imaging or comparison with any available imaging such as plain films may be of further benefit in evaluating this if clinically appropriate.