Clinical question to be answered: Evaluate for etiology of new onset of severe headaches and epistaxis. Signs and symptoms: Complains a one week history of severe headaches No evidence of hemorrhage, edema, mass effect, midline shift or hydrocephalus. Cortical sulci, ventricular system and CSF cisterns remain within normal. There is apparent crowding of cerebellar tonsils at the level foramen magnum which may represent ectopia of the cerebellar tonsils. This finding can be further evaluated with an MRI exam. Calvarium is intact. Mastoid air cells and limited view of paranasal sinuses are unremarkable.
Negative CT of brain for any acute findings. Possible ectopic cerebellar tonsils as detailed.