refractory headache. Brain MRINo evidence of acute ischemic or hemorrhagic lesion.There is no evidence venous congestive encephalopathy.The 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, or abnormal contrast enhancement. 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.3D MRV brain phase contrast technique and post-gadolinium with maximum intensity projections of the superficial/deep intracranial venous drainage demonstrate hypoplastic left distal transverse and sigmoid sinus. The right transverse and sigmoid sinus appear to be normal. Forward flow through bilateral transverse and sigmoid sinuses.There were linear low signal intensities within the dural sinuses especially bilateral transverse and sigmoid sinuses. These are most likely indicating fibrous septae, however, linear thrombus cannot be completely excluded. Normal flow enhancement in the superior sagittal sinus, transverse sinuses, sigmoid sinuses, internal cerebral veins, vein of Galen and straight sinus.
1. No evidence of acute ischemic or hemorrhagic lesion.2. No abnormal enhancement.3. No evidence of venous congestive encephalopathy.4. Patent major dural sinuses with maintained forward flow. Left distal transverse sinus and sigmoid sinus appear to be hypoplastic as described above. 