Diagnosis: Chronic post-traumatic headache, intractableClinical question: Workup for post concussion syndrome and chronic migraines that are slowly evolving to accompany lethargy, lightheadedness, vertigo, hyperacusis on Rt 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.A couple punctate left frontal periventricular white matter lesions are present which in isolation are of little clinical significance.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 anterior cerebral artery at the A2 segment appears to be azygos. The right A1 segment appears larger than the left A1 segment.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.
MRI of the brain is within normal limits. A couple punctate lesions in the left frontal lobe are likely of little clinical significance.