Neuro_MRA_Head: Transfer from OSH.

MRA OF THE HEAD WITHOUT CONTRAST:

CLINICAL HISTORY:

Right-sided tinnitus. Headaches. Pulsating noise in the right ear for two weeks. Vertigo. No history of cancer. No history of recent 

trauma.

FINDINGS:

There is abnormal hyperintensity compatible with abnormal arterial flow within the right cavernous sinus and retroclival venous plexus. The right superior ophthalmic vein appears slightly larger than the left. The right internal carotid, anterior, and middle cerebral arteries appear intact. No cavernous carotid aneurysm identified.

The left internal carotid, anterior, and middle cerebral arteries appear intact.

Intact basilar artery and posterior cerebral arteries. Antegrade vertebral artery flow bilaterally. Left vertebral artery is larger than right. There is tortuosity of the vertebrobasilar system.

Superior cerebellar arteries are patent bilaterally.  

Anterior-inferior cerebellar arteries are patent bilaterally. Left posterior-inferior cerebellar artery is patent. No definite asymmetric enlargement of external carotid artery branches seen. No 

aneurysm or arteriovenous malformation.

Visualized portions of the superior sagittal, as well as the straight and sigmoid sinuses appear 

intact.

IMPRESSION:

1.  Asymmetric prominence of flow within the right cavernous sinus, as well as in the retroclival venous plexus and subtle enlargement of the right superior ophthalmic vein. Findings are worrisome for right 

cavernous carotid artery fistula, likely indirect.  

2.  No aneurysm, arteriovenous malformation, pathologic vessel occlusion or flow-limiting stenosis seen.

3.  Clinical correlation with respect to presence of chemosis - conjunctival edema is recommended. Neurointerventional consultation 

is recommended.