Diagnosis: Chronic migraine without aura, with intractable migraine, so stated, without mention of status migrainosusClinical question: intractable headacheSigns and Symptoms: intractable headache The CSF spaces are appropriate for the patient's stated age with no midline shift. No foci of diffusion restriction are appreciated.There is a subtle 3 mm T2 hyperintense focus within the center of the pons which is associated with some mild contrast enhancement which measures approximately 5 mm x 4 mm in axial dimensions. It is slightly eccentric towards the left side. It is low signal on susceptibility weighted imaging.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 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.Incidental note is made of congenital fusion of C2 and C3.
1.There is a small pontine lesion present which is nonspecific. One possibility is that this represents capillary telangiectasia.2.There is no evidence for intracranial mass lesion.