Chronic left sided headache with history of left pulsatile tinnitus. There is no acute infarct or intracranial hemorrhage. There are few punctate T2-hyperintense subcortical foci in the frontal lobes. The cerebellar tonsils reach up to 5 mm below the foramen magnum. Otherwise, the brain shows normal signal characteristics and normal morphology. There is no abnormal intracranial contrast enhancement. The ventricles and the other CSF-containing spaces are normal in size. There is no extra-axial fluid collection. There is no midline shift or brain herniation. The major intracranial vascular flow voids are preserved. Major venous sinuses are also patent. No mass within the cerebellopontine angles or internal auditory canals is appreciated. The internal auditory canals are symmetric as well as the seventh/eighth cranial complexes. There is a partially empty sella.There is trace mucosal thickening in the ethmoid sinuses. Mastoid air cells are clear. The orbits are unremarkable.
1.Few punctate T2-hyperintense lesions in the frontal subcortical white-matter are nonspecific and essentially within normal limits for age. These may be related to prior inflammation, infection or perhaps related to migraines.2.Partially empty sella is commonly an incidental finding, but can be seen with pseudotumor cerebri in the proper clinical setting.3.The cerebellar tonsils are borderline low-lying measuring up to 5 mm below the foramen magnum. This finding can also be seen with pseudotumor cerebri but may also be unrelated.