Patient History
Severe headaches waking from sleep, history of hypertension, and migraine.
Findings
MRI brain: These images demonstrate a partially empty sella. There is dilatation of the optic nerve sheath complex bilaterally with imaging findings suggestive of mild papilledema. There is dilatation of the Meckel's cave region dural enlargement. No focal masses are seen in the brain. There are punctate areas of high signal intensity in the subcortical white matter.
CTA HEAD: The anterior and middle cerebral arteries are patent. There is a normal anterior communicating artery. The basilar artery is patent. There is a near complete fetal origin of the left posterior cerebral artery. The posterior cerebral arteries are patent. No intracranial arterial aneurysm. No abnormally enhancing parenchyma or mass seen.
CTV HEAD: The superior and inferior sagittal sinuses are patent. The straight sinus and confluence sinuses are patent. Gradual tapering and stenosis of the distal transverse sinuses bilaterally about the origin of the sigmoid sinuses, moderate on the left and mild-to-moderate on the right. Contrast opacification is seen within the proximal jugular veins bilaterally.
Impressions
Imaging findings suggestive of idiopathic intracranial hypertension (pseudotumor cerebri) based on optic nerve sheath dilatation, mild papilledema, and dilatation of the dural spaces including partially empty sella. Recommend corroboration with opening pressure sampling.
Tapered appearance of both transverse sinuses with moderate narrowing distally on the left and mild to moderate narrowing on the right. No dural venous sinus thrombosis.
Patent intracranial arterial vasculature. No intracranial arterial aneurysm.
