 Exam is motion limited despite reported sedation and swelling.There is significant abnormal intrinsic T1 hyperintensity throughout the transverse and sigmoid sinuses slightly more extensive on the left. There is also abnormal intrinsic T1 hyperintensity to a lesser degree in the superior sagittal sinus there is corresponding prominent susceptibility in these areas consistent with thrombus. On SWI, although motion limited, there are areas of patchy susceptibility along the right greater than left parieto-occipital regions representing petechial hemorrhage. Addition, there are curvilinear areas of intrinsic T1 hyperintensity susceptibility along the ventricular margins, especially along the atria and body of the lateral ventricles which likely relate to terminal and medullary veins with associated thrombosis. There is prominent susceptibility along the confluence of the deep cerebral veins. Internal cerebral veins bilaterally appear to demonstrate intrinsic T1 hyperintensity and susceptibility concerning for thrombosis.Diffusion weighted images are somewhat limited as the ADC images despite reprocessing do not appear fully diagnostic. There is no evidence of corresponding large area of diffusion-weighted abnormality to suggest frank venous infarct at this time. There is mild diffusion restriction within the splenium of the corpus callosum as well as along the right genu of the corpus callosum likely representing sequela of acute neuronal insult. There is also questioned mild diffusion restriction within the deep cerebral white matter bilaterally. T2-weighted images demonstrate a few asymmetric peripheral flow-voids which may represent venous collaterals. The ventricles and sulci are within normal limits. The cisterns remain patent. There is no midline shift or mass effect. No extra-axial fluid collection is identified. Myelination appears appropriate for stated age.Normal flow-voids are demonstrated in the major intracranial arterial vascular structures. The midline structures and craniocervical junction are within normal limits. Visualized paranasal sinuses are opacified with fluid signal.MRV is also limited by patient motion and appears to demonstrate minimal if any flow related enhancement in left greater than right transverse and sigmoid sinuses, although the contour slightly irregular especially on the left side which may indicate collaterals. No flow related enhancement detected in the superior sagittal sinus. There appears be flow related enhancement in the inferior sagittal sinus although possibly discontinuous posteriorly, as well as suggestion of a discontinuous straight sinus. There appear to be collaterals between the thrombosis superior sagittal sinus and inferior sagittal sinus. The internal jugular veins are not well assessed on this MRV head exam.Dedicated images through the sella are significantly motion limited, although demonstrate a normal height of the pituitary gland. No focal abnormal signal intensity or mass is grossly seen within the pituitary gland. The pituitary stalk lies in the midline. Suprasellar cistern, optic chiasm, cavernous sinuses and intracranial portions of the optic nerves appear grossly unremarkable. However, assessment for cavernous sinus thrombosis is not possible on this noncontrast exam. After discussing with referring service, postcontrast images were elected to not be obtained given significant findings on MRI/MRV and recent renal compromise.
1.Limited exam due to patient motion and technical factors. Diffuse dural venous sinus thrombosis, which may be partial in the transverse and sigmoid sinuses bilaterally, while more extensive in the superior sagittal sinus. Inferior sagittal sinus does appear to be patent as do portions of the straight sinus, with evidence of scattered venous collaterals.2.Prominent susceptibility along the confluence of deep cerebral veins, which may indicate additional thrombosis. In addition, there are scattered medullary and terminal veins with associated abnormal signal suggestive of thrombosis. Cavernous sinus not fully assessed on this noncontrast exam.3.Diffusion-weighted imaging limited due to technical factors, although no definite evidence of large venous infarct at this time. Areas of minimal petechial hemorrhage in the right greater than left posterior cerebral hemispheres.4.Mild diffusion restriction in portions of the corpus callosum which likely represents sequela of acute neuronal insult. Additional questioned mild diffusion restriction the deep white matter which could represent venous congestion, early venous ischemia.