Diagnosis: Migraine without aura, not intractable, without status migrainosusClinical question: assess for thrombusSigns and Symptoms: headache with right visual field loss, h/x of hemiplegic migraines MRI of the brainNo diffusion weighted abnormalities are appreciated.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 appears be an arachnoid granulation in the junction of the left transverse sinus with the sigmoid sinus. This appearance has not changed since the MRI from 2/19/2016.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 are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRV brain:The dural venous sinuses are patent. Straight sinus, internal cerebral veins and basal veins are identified and appear patent. The left jugular bulb and left sigmoid sinus are small. The left transverse sinus does not opacify. CT exam demonstrates congenitally small left jugular bulb and sigmoid sinus groove.
1.Hypoplastic left transverse sinus associated with congenitally small left sigmoid sinus and jugular bulb. There is no convincing evidence for dural sinus thrombosis.2.No abnormal lesions are identified within the brain parenchyma to explain the patient's right visual field loss