Paranasal sinus CG is most commonly observed in middle-aged males, arises in the frontal sinus, and typically presents with orbital symptoms. Both open and endoscopic techniques can be used with high success rate. The present study represents the first attempt in the literature to construct a clinical profile of this rare entity.

Our results suggest that hemodynamic intracranial vascular stenoses may be less responsive to medical therapy, while stenotic lesions caused by plaque destabilization or in perforator territories may benefit from aggressive medical management with delayed or staged endovascular therapy. Recurrence of stroke may be affected both by vascular territory and by aggressive risk factor control, although the latter remains difficult to evaluate.

Context:Skull base venous anatomy.Aims:While prior studies have focused on the efficacy of conventional fluoroscopic venography and multidetector computed tomography venography to evaluate the inferior petrosal sinus (IPS) before image-guided intervention (such as dural venous sinus sampling), we believe that routine magnetic resonance imaging (MRI) may provide reliable structural information helpful for planning without the need for further imaging.Settings and Design:Retrospective review of brain MRI.Materials and Methods:Retrospective analysis was carried out on IPSs on contrast-enhanced T1-weighted MR images. Qualitative measurements were made regarding the grade of patency of the IPS, variation in IPS drainage pattern, and grading of the ipsilateral transverse and sigmoid sinuses (TS and SS).Statistical Analysis Used:Pearson's product-moment correlation.Results:Evaluation of a total of 148 IPSs revealed that 91% of cases were grade 3 or grade 2 (either fully or mostly visualized), with 65% of cases demonstrating “typical” (type A) drainage directly into the internal jugular vein and no statistically significant correlation between the patency of the IPS and the dominance of the ipsilateral TS/SS. A bilateral concordance rate of 77% was also observed.Conclusions:Our analysis indicates that routine thin-slice contrast-enhanced T1-weighted MRI can provide sufficient anatomic detail to identify typical drainage pattern of the IPS in a majority of cases. In cases where routine drainage was not identified, spatial resolution was not sufficient to further delineate complex drainage anatomy. No correlation was observed between the TS/SS dominance and patency of the ipsilateral IPS.

Isolated fourth cranial (trochlear) nerve palsy is an uncommon occulomotor nerve palsy typically secondary to ischemia, inflammation/infection, or mass effect. Due to its positioning within the cavernous sinus, pathology of the deep cerebral venous system would theoretically predispose to palsy of this nerve. We present a case of a patient presenting with isolated trochlear nerve palsy in the setting of angiographically-confirmed direct carotid-cavernous fistula.

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