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32b - Answer: 50-year-old female presents with vision changes

Pomeranz, Stephen
Stephen J Pomeranz, MD
Chief Medical Officer, ProScan Imaging. Founder, MRI Online
Includes DICOM files

HISTORY: 

This 50-year-old female presents with vision changes.

(QUIZ ANSWER) NOT A FINDING IN THIS CASE: 

Ventricular system is abnormal in configuration.

Using the diagnostic web viewer, we have provided images that assist in telling our clinical story. Areas of significance are indicated below.

FINDINGS:

The ventricular system is normal in size and configuration. No midline shift or neoplasm is appreciated. There is altered signal within the temporo-occipital region with associated restrained diffusion with an enhancing focus along its inferior margin, with suggestion of a hemorrhagic infarct likely venous in nature. There is suggestion of altered flow signal within the left transverse and sigmoid sinus as well as involving part of the jugular bulb suggestive of sinus thrombosis. 

T2 vascular flow voids are within normal limits. Paranasal sinuses and mastoid air cells are well aerated and normal in appearance with mucosal thickening involving the right maxillary sinus and right ethmoid air cells. There are mucous retention cysts seen in both maxillary sinuses. 

CONCLUSION

Altered flow signal within the left transverse and sigmoid sinus and portion of the left jugular bulb suggestive of venous thrombosis with adjacent altered signal within the left temporo-occipital region with focus of enhancement suggestive of a hemorrhagic infarct. MRV may be helpful for further evaluation as would anticoagulation.

LESSON 3, TOPIC 66

Case Challenge: Brain MRI Cases

Case Challenge

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Content reviewed: July 23, 2021

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