Migraine and bipolar disorder with an acutely worsened headache over the past month. History of DVT and weight issues. MRI: There is a partially empty sella. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma appears 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 orbits, and scalp soft tissues are grossly unremarkable. There are secretions in the right posterior ethmoid sinus.MRV: The right transverse sinus, sigmoid sinus and proximal intracranial jugular vein are asymmetrically enlarged with regional transosseous venous collaterals. There is narrowing of the internal right jugular vein more inferiorly in the upper neck, which is partially imaged, but possibly related to thrombosis. The left transverse sinus is hypoplastic. The remainder of the imaged cerebral venous drainage system is within normal limits, without evidence of intracranial venous thrombosis.
1.Nonspecific partially empty sella, which may be a manifestation of pseudotumor cerebri, but no evidence of intracranial hemorrhage, mass, or acute infarct. 2.Enlarged right transverse sinus, sigmoid sinus and right proximal jugular vein with right transosseous venous collaterals likely related to narrowing of the right extracranial internal jugular vein more inferiorly, which may be related to thrombosis. A venous Doppler ultrasound of the neck may be useful for further evaluation.