Reason: severe frontal sinus headaches after sinus surgery 2.5 years ago, DM2 History: severe recurrent week long presssure headaches, new onset in 62 y/o The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate small frontal sinuses and opacification of the anterior ethmoid air cells and frontal sinuses is also scattered opacities in the left sphenoid sinus and mucosal thickening in the maxillary sinuses. Patient appears to be status post paranasal sinus surgery. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.
1.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related. 2.There is paranasal sinus opacification present. Etiology cannot be established on this exam. There is no associated lesion within the brain parenchyma appreciated on this exam