Diagnosis: Pneumonia due to methicillin resistant Staphylococcus aureusClinical question: eval cavernous sinus thrombosisSigns and Symptoms: infection MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. No foci of diffusion restriction are appreciated within the brain parenchyma.The left sigmoid sinus flow void is absent. This was also the case on the prior examMany of the pulse sequences are degraded due to patient motion. Susceptibility weighted imaging is severely degraded due to patient motion. To extent of visualization no significant hemorrhages appreciated intracranially.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.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 visualized portions of the paranasal sinuses demonstrate mucous retention cysts in the maxillary sinuses and mucosal thickening in the sphenoid sinuses. The visualized portions of the mastoid air cells demonstrate opacification of the mastoid air cells and middle ears. The patient is intubated. The visualized portions of the orbits are intact.MRI neck:MRI of the neck is severely degraded due to patient motion. There is signal hyperintensity within the left jugular vein. This was also present on the prior exam. Previously noted T2 signal hyperintensity within the perivertebral soft tissues appears to persist.
1.Findings suggest persistent left jugular vein and left sigmoid sinus thrombosis. No associated evidence for cerebral congestion is appreciated. Due to significant motion artifact subtle abnormalities readily overlooked. The previously noted epidural collection is not adequately assessed on this exam due to patient motion.2.There is no convincing evidence for cavernous sinus thrombosis or intracranial mass on the basis of this MRI of the brain. However, the exam is limited due to patient motion which may obscure more subtle abnormalities.3.MRI of the neck is severely degraded due to patient motion despite use of sedation. As a result no meaningful interpretation can be provided. The previously noted inflammatory change within the perivertebral soft tissues does not appear to have significantly changed when compared to the prior exam to the extent of visualization possible. Due to significant rotation of the images if clinically appropriate, alternatives may include use of general anesthesia or performing CT exam instead.