Presentation
Persistent headache over 12 days without significant relief. She states that 12 days ago she first felt strain in both eyes with eye movements, but over the course of 7 days this developed into a pounding, throbbing headache behind both eyes, nonradiating rated up to 9/10. Associated with photophobia, blurry vision, and photophobia and alleviated by dim light.
Patient Data
There is evidence of dilatation of the right superior ophthalmic vein. Note is also made of direct connection with the superior sagittal dural venous sinus via a transcalvarial venous tributary compatible with sinus paracranii. The intraconal and extraconal fat of the right orbit is preserved. The extraocular muscles maintain normal morphology. The globes are normal in appearance. The imaged intracranial structures are unremarkable. Note is made of normal opacification of imaged portions of the dural venous sinuses. There is no significant soft tissue swelling of the facial soft tissues. The nasal septum is midline. The imaged paranasal sinuses are clear. The mastoid air cells are well aerated.
The optic nerves are symmetric. The extraocular muscles are unremarkable. The superior ophthalmic vein curves upon itself in the region of the superior orbit below the orbital roof. It could appear mass-like, but on the thin section images it is not a varix and it just simply curves upon itself. The cavernous sinuses are symmetric on both sides.
Sequences under Valsalva were attempted, but were severely limited due to motion artifact secondary to patient discomfort/pain.
Case Discussion
This is a case of a sinus pericrani. The patient was admitted to the neurology service and was treated for migraines. She was started on valproic acid and the patient improved over the course of her hospital stay. Regarding the sinus pericrani, this finding was though to be an incident finding of a congenital anomaly and was not contributing to the patient's symptoms. No further workup was pursued.
Unable to process the form. Check for errors and try again.