Stabbing right-sided headache, worse in life. Assess for vascular dissection or subarachnoid hemorrhage. The study is limited by patient motion. Also, immediately following gadolinium injection, the patient reported warm sensation in her chest and significant nausea. The examination was halted. Symptoms resolved within 2 minutes without treatment but no postcontrast images were obtained for the MRA of the neck or MRV of the cranium.MRI BRAIN WITHOUT CONTRAST:The brain demonstrates normal morphology and signal characteristics. There is no space-occupying lesion, midline shift or brain herniation. The ventricles and the other CSF-containing spaces are normal accounting for predominantly CSF filled sella, compatible with partially empty sella. There is no abnormal diffusion restriction or susceptibility effect to indicate acute stroke or intracranial hemorrhage.There is no gross orbital abnormality. There is no destructive skull lesion. Thickening of the subcutaneous fat along the scalp likely relates to patient body habitus. There is mild prominence of the optic nerve sheath although remaining within normal limits. No definite posterior scleral flattening is identified.CRANIAL MR VENOGRAPHY WITHOUT AND WITH CONTRAST:As discussed above, no postcontrast MR venography was performed. Motion also limits the examination.There is no sign of significant dural venous thromboses on the noncontrast MR venography. Attenuation of the flow-related signal at the junction of the transverse and sigmoid sinuses is a common imaging finding of no clinical significance.CRANIAL MR ANGIOGRAPHY WITHOUT CONTRAST:Flow-related signal in the intracranial internal carotid arteries and the paired anterior and middle cerebral arteries and their major branches is preserved as well as the vessel caliber. Similarly, the vertebrobasilar system shows no significant stenosis or aneurysm.NECK MR ANGIOGRAPHY WITHOUT AND WITH CONTRAST:As discussed above, only noncontrast enhanced images are available. There is bilateral attenuation of flow-related signal in the carotid bulbs which likely relates to turbulent flow. Otherwise, the cervical carotid arteries show preserved flow-related signal and caliber. Similarly, the cervical vertebral arteries are also preserved except for suboptimal visualization of the origin of the left vertebral artery which may reflect technical limitation of noncontrast enhanced cervical MR angiography. Aortic arch branching pattern is conventional.The fat saturated precontrast axial images of the neck show no sign of intramural hematoma/vessel dissection. There is asymmetric enlargement and lobulation of thyroid gland, more pronounced on the left, probably reflecting the presence of thyroid nodules.
1.The examination is limited as described above because of inability to complete the examination following the contrast injection as well as patient motion throughout the remainder of the examination.2.There is no definitive intracranial abnormality.3.There is no definite cervical or intracranial artery stenosis accounting for the above described limitations. There is also no sign of vessel dissection.4.No gross evidence dural venous thrombosis.5.Partially empty sella is nonspecific and may represent a normal variant. However, given the incidental note of increased fat within the scalp suggestive of patient's body habitus, as well as history of headaches and relatively young age, clinical correlation should be made for idiopathic intracranial hypertension.6.Asymmetric thyroid gland enlargement and lobulation probably reflect multinodular goiter.