Diagnosis: Dizziness and giddiness Unspecified abnormalities of gait and mobility Unspecified sensorineural hearing lossClinical question: Evaluate vesselsSigns and Symptoms: dizziness, imbalance, Right Asymmetrical SNHL MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified. The posterior communicating arteries are not readily identified. There is triplication of the anterior cerebral artery. The right vertebral artery is hypoplastic intracranially.MRV brain:The dural venous sinuses are patent. Straight sinus, internal cerebral veins and basal veins are identified and appear patent. There is narrowing of the left transverse sinus at the junction with the sigmoid sinus. A 2-D time-of-flight MR venogram demonstrates significantly decreased signal from the left transverse sinus and sigmoid sinus relative to the right transverse sinus and sigmoid sinus. This could be a result of lower outflow. There are prior MRI of the brain imaging studies dating back to 5/5/2010 which indicate that asymmetry in the appearance of the transverse and sigmoid sinus has to some degree been present on prior exams.
1.No evidence for intracranial cerebrovascular occlusive disease.2.No evidence for intracranial aneurysm.3.There is narrowing at the junction of the left transverse and sigmoid sinuses which appears to impede venous outflow. It is possible that this is a result of an arachnoid granulation and may be long-standing to some degree.