Suspected CC fistula History: blood in Schlemm's canal, evidence of elevated episcleral venous pressure, and pulsatile tinnitus. Brain MRI: The cavernous sinuses are unremarkable. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull and scalp soft tissues are grossly unremarkable. There is a left maxillary sinus retention cyst. There is also an adenoidal retention cyst. There is a mildly prominent right retropharyngeal lymph node that measures 6 mm in short axis. There is a nasal septal defect. Brain MRA: There is an anomalous origin of the right opthalmic artery from the right middle meningeal artery. Otherwise, there is no evidence of significant steno-occlusive lesions, arteriovenous malformations, or cerebral aneurysms.Orbit MRI: There is mild prominence of the bilateral superior opthalmic veins. Intraocular hemorrhage cannot be resolved on this exam. The ocular adnexa appear to be intact bilaterally. There is no evidence of intraorbital mas or abnormal enhancement.
1. Nonspecific mild prominence of the bilateral superior opthalmic veins without discernible evidence of a large dural atriovenous fistula, although MRA has limited sensitivity for arteriovenous fistulas. 2. Intraocular hemorrhage cannot be resolved on this exam, but there is no evidence of intraorbital mass lesions. 3. Mildly prominent right retropharyngeal lymph node, which is nonspecific. Perhaps dedicated neck imaging may be useful for further evaluation.