Headache(784.0) [784.0], Reason for Study: ^Reason: headache x 3 months, vision changes in R eye History: see above Brain MRIThe ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.Brain MRV3D MRV brain using 3D Phase Contrast technique with velocity encoding as 5cm/sec and 15cm/sec were obtained. Due to inadequate demonstration of the dural sinuses on this MRV most likely related to technical issues, overall image quality is poor.However, major dural sinuses appear to be patent especially on MRV obtained with venc=15. There are possible venous sinus stenosis or intra-luminal filling defects especially on bilateral transverse- sigmoid sinus junctions. Further evaluation with Gadolinium enhanced MR venography can be considered for more precise evaluation of dural sinuses.In addition, diagnostic angiography with dural sinus pressure mapping can be considered for identifying endovascularly manageable idiopathic intracranial hypertension through Neurointerventional radiology consultation (page:9287).
1. Normal brain MRI2. Patent major dural sinuses. Possible stenosis or intra luminal filling defects on bilateral transverse-sigmoid junctions. Contrast enhanced MRV can be considered for further evaluation. Intra dural sinus pressure mapping can also be considered for identifying luminal stenosis which may show significant pressure gradient. 