Dizziness and giddiness [R42] / Tinnitus, bilateral [H93.13], Reason for Study: ^Reason: Persistent tinnitus (pulsatile) and vertigo. Evaluate for vascular abnormality or schwannoma History: Persistent tinnitus (pulsatile) and vertigo. Brain MRI:No evidence of acute ischemic or hemorrhagic lesion on this scan.The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate normal ICAs, MCAs and ACAs. Vertebrobasilar system appears to be normal.Considering the patient's symptom (pulsatile tinnitus), potential vascular lesions include dural arteriovenous shunts which cannot be excluded with MR angiography. Thus, if clinically indicated, diagnostic catheter angiography can be considered.
1. Normal brain MRI2. No evidence of arterial aneurysm, stenosis or vascular malformation.Comment: Diagnostic catheter angiography can be considered if clinically indicated. 