Other facial nerve disorders [351.8], Reason for Study: ^Reason: LT hemifacial spasm History: as above There is fluid collections on the left mastoid air cells indicate possible left mastoiditis.On post Gad enhanced images, the left transverse sinus and sigmoid sinus were not well seen. This could represent normal variation of hypoplastic left transverse and sigmoid sinus. This possibility is supported by the finding of relatively smaller left jugular bulb comparing to that of right side.In addition, especially on the axial scan (series 1201, image 29, 32 and 33/90), there are multifocal non-enhancing areas which are surrounded by enhancement. These lesions could represent intra-dural sinus fibrous septae more likely. Other possibility is dural sinus thrombosis without complete occlusion. There is no evidence of brain parenchymal edema or hemorrhages suggesting venous congestive encephalopathy. Considering the patient's presenting symptoms and lack of other MRI findings suggesting venous congestive encephalopathy, the chance of being dural sinus thrombosis would be very low. The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. Mucosal thickenings on bilateral maxillary sinuses and sphenoid sinus with a small retention cyst on the left maxillary sinus.
1. No evidence of acute ischemic or hemorrhagic lesion.2. Hypoplastic left transverse and sigmoid sinus with intra-luminal filling defects indicating intra dural fibrous septae, the chance of dural sinus thrombosis is low.3. Left mastoid air cell fluid collections. Mucosal thickenings on paranasal sinuses as described above.