Clinical question: Evaluate head. Signs and symptoms: Dizziness, tinnitus, change in vision and headache. Nonenhanced brain MRI: Negative diffusion-weighted series.Examination demonstrates few nonspecific punctate foci of FLAIR hyperintensity only in the subcortical white matter of cerebral hemispheres.The anatomical morphology as well as the signal intensity of brain parenchyma otherwise remains within normal on all MRI sequences.Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and brain myelination.The signal void of major intracranial arterial branches are identified.Signal intensity of the intracranial venous sinuses are unremarkable.Unremarkable calvarium, soft tissues of the scalp, orbits and well pneumatized bilateral mastoid air cells and middle ear cavities.There is complete opacification of a chamber of the sphenoid sinus in the midline with T1 hyperintense and mixed hypo and hyperintense signal on T2-weighted images. Finding is suggestive of chronic sinus disease of the sphenoid. The rest of the paranasal sinuses remain well pneumatized. The finding could explain patient's headache and follow-up with maxillofacial CT exam is recommended for better assessment.
1.Minimal scattered nonspecific punctate foci of FLAIR hyperintensity in the subcortical white matter of cerebral hemispheres and unremarkable brain MRI otherwise.2.Complete opacification of a single chamber of the sphenoid sinus suggestive of chronic sinus disease. Follow-up with CT of paranasal sinuses is recommended for further assessment. The rest of the paranasal sinuses as well as bilateral mastoid air cells and middle ear cavities remain well pneumatized.