Mycosis fungoides and leptomeningeal disease: vision loss and loss of vision acuity with 3rd nerve palsy and ptosis. Orbits MRI: There is high T2 signal and mild hyperenhancement of the left inferior, medial, and superior oblique muscles. There may also be mild high T2 signal in the right inferior recuts muscle. The bilateral globes, lacrimal glands, and optic nerves are otherwise unremarkable. Brain MRI: There is diffuse enhancement of the bilateral oculomotor nerves, left more than right. There also appears to be enhancement of the cisternal segments of the bilateral trigeminal nerves, left more than right. Furthermore, there appears to be a greater degree of diffuse enhancement involving the bilateral facial nerves than usual. There is no evidence of abnormal enhancement in the cerebral sulci. There is nonspecific high T2 signal in the left peritrigonal white matter. The rest of the brain parenchyma appears to be unremarkable. There is no evidence of intracranial hemorrhage or acute infarct. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.Brain MRA: There is no evidence of significant steno-occlusive lesions or aneurysms.
Abnormality involving the bilateral oculomotor and trigeminal nerves, left more than right, as well as possibly the facial nerves, with denervation effects in the extraocular muscles, particularly on the left side may be related to neoplastic involvement.