25 years, Female, headache. Also history of Legionnaire's disease. MRI BRAIN: There is extensive susceptibility effect involving multiple bilateral cortical veins as well as the superior sagittal sinus and bilateral transverse sinuses with areas of T1 hyperintensity consistent with venous thrombosis.There is no evidence of acute infarct. There are bilateral subdural fluid collections along the bilateral cerebral convexities as seen on recent CT with mild local mass effect, particularly along the right frontal convexity. Subdural fluid is also noted along the falx and tentorium. There is no midline shift or frank herniation, although there is mildly diminutive appearance of the ventricles and CSF cisterns which may be related to mild cerebral edema.No evidence of acute infarct. No intraparenchymal edema or hemorrhage. No parenchymal signal abnormality. There are minimal areas of apparent leptomeningeal enhancement such as at the left internal auditory canal which are nonspecific in this setting. No clear MRI evidence of intracranial infection.Paranasal sinuses and mastoid air cells are clear. Calvarium and intracranial soft tissues are grossly unremarkable.MRA HEAD: The intracranial internal carotid arteries demonstrate no significant stenosis. The middle and anterior cerebral arteries are also patent. The vertebral arteries, basilar artery, and posterior cerebral arteries also are patent with no significant stenosis. No evidence of aneurysms or vascular malformations. Patent anterior communicating and right posterior communicating artery. Left posterior communicating artery is not definitively seen which is normal variant.MRV HEAD: There is thrombosis involving the superior sagittal sinus as well as the proximal and mid aspects of the transverse sinus. The inferior sagittal sinus, very distal transverse sinuses, sigmoid sinuses, and visualized portions of the bilateral internal jugular veins appear patent. Internal cerebral veins, vein of Galen, basal veins of Rosenthal, and straight sinus are patent.
1. Extensive venous sinus thrombosis involving the entire superior sagittal sinus and majority of the bilateral transverse sinuses. The sigmoid sinuses and bilateral internal jugular veins are patent. There is also extensive thrombosis involving multiple cortical veins.2. There are bilateral subdural effusions which are nonspecific and are associated with mild local mass effect along the right frontal convexity. No findings to suggest empyema. There is mild dural enhancement which while may be related to the venous thrombosis, in association with the subdural effusions there is a possibility that this represents sequela of prior lumbar puncture. There are minimal apparent areas of leptomeningeal enhancement such as the left internal auditory canal which is nonspecific in the setting and may actually represent venous congestion. No definite MRI evidence of intracranial infection, but would suggest correlation with CSF analysis to better exclude infection.3. Suggestion of mildly diminished CSF spaces including the basilar cisterns and mildly diminished caliber of the ventricular system which may reflect mild cerebral edema. There is however no evidence of frank herniation.4. No evidence of parenchymal edema or parenchymal hemorrhage. Dr. Ali discussed findings with Dr. Thoburn at 1713 hrs on 8/3/2016.