Neuro_MR_Brain: 21 F, postpartum headache.

MRI BRAIN WITH AND WITHOUT CONTRAST:

 

CLINICAL HISTORY: 19-year-old woman, severe headache postpartum, concern for acute intracranial process and dural venous sinus thrombosis.

FINDINGS: 

 

Parenchyma: No acute hemorrhage, infarction, mass, or abnormal intraparenchymal enhancement.

 

Ventricles and extra-axial spaces: There is diffuse pachymeningeal enhancement. There is marked enlargement of the pituitary gland with suprasellar extension abutting without mass effect on the chiasm, likely mostly due to recent gravid/postpartum state, however degree may be exacerbated by intracranial hypotension. No evidence of pituitary hemorrhage, however this is suboptimally evaluated without thin cuts through the sella. The dural venous sinuses and cortical veins appear engorged, however there areas no extra-axial collection, midbrain sagging, or epidural plexus engorgement. 

 

Orbits: Normal. 

 

Visualized paranasal sinuses: Small mucous retention cyst in the left maxillary sinus. 

 

Mastoid air cells: Clear. 

 

Bones: Normal. 

 

Additional comment: MRV and postcontrast BRAVO images show engorged, widely patent dural venous sinuses. 

 

IMPRESSION: 

 

1. Diffuse pachymeningeal enhancement and cerebral venous engorgement, consistent with changes of intracranial hypotension. 

 

2. Diffusely enlarged pituitary gland, mostly due to recent gravid/postpartum state, however degree of enlargement is likely to be exaggerated by intracranial hypotension. 

 

3. No dural venous sinus thrombosis. 

 

4. No evidence of infarct, mass effect, hemorrhage, or abnormal intraparenchymal enhancement.