Clinical question: Two weeks post partum with headache. Signs and symptoms: Sudden onset of headache. Pre-and post-enhanced pituitary MRI:Examination demonstrates normal signal intensity and size of pituitary gland and with normal homogeneous pattern of enhancement. Pituitary stalk is in midline and normal pattern of enhancement.Hypothalamic region including suprasellar visual complex of the straight normal signal intensity and without abnormal enhancement.Unremarkable bilateral cavernous carotids and with normal pattern of enhancement.Unremarkable sphenoid sinus and skull base.Pre-and post-enhanced MRV:Examination demonstrate no convincing evidence of signal abnormality of the intracranial venous sinuses.Post-enhanced images demonstrate normal enhancement and size of the superior sagittal sinus, a dominant large right transverse and sigmoid sinus as well as right jugular bulb and proximal right internal jugular vein. Normal visualization of bilateral thalamostriate veins, internal cerebral veins, vein of Galen and straight sinus as well as the confluence of sinuses. There is a uniformly very small size caliber of the right transverse sinus, right sigmoid sinus, right jugular bulb and right proximal internal jugular which is believed to represent a normal anatomical variation. This can be further assessed with a CTV exam if clinically concerned for thrombosed sinus persist. There is no asymmetry in visualized bilateral cerebral cortical veins. Negative diffusion weighted series. The anatomical morphology and the signal intensity of brain parenchymal remains within normal on all MRI sequences.Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and brain myelination.No detectable susceptibility signal abnormality is noted.The signal void of major intracranial arterial branches are identified.The signal intensity of the intracranial venous sinuses are within normal limits and with normal pattern of enhancement.
1.Negative pre-and post enhanced pituitary MRI.2.Negative pre-and post enhanced MRV. There is anatomical variation all uniformly small and hypoplastic left transverse and sigmoid sinuses as well smaller size of the left jugular bulb and proximal left internal jugular. If clinical concern for thrombosed sinus persist further assessment with CTV is recommended.