Unspecified ptosis of eyelid Paralytic strabismus, third or oculomotor nerve palsy, partialClinical question: any change in 3 rd nerve lesion or other abnormalitiesSigns and Symptoms: 3rd nerve lesion, migraines, ptosisComments: Please do thin cuts FIESTA sequence, compare with previous imaging for any changes. Mom would like MRI either May 8th or 15th if possible. MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. The small and subtle enhancing focus adjacent to the right midbrain at the expected location of the origin of the right oculomotor nerve is less conspicuous on the current exam. It is better seen on the coronal post gadolinium axial SPGR images (series 1701 image 48). It can also be seen on 3D FIESTA - image 47 series 1401. It is abutting the medial division of the superior cerebellar artery. It is best seen when comparing to the 7/11/13 exam when it was more conspicuous.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate scattered opacities with opacification of the maxillary sinus and mild mucosal thickening in some of the ethmoid air cells. The visualized portions of the mastoid air cells are partially opacified. MRI orbits:The eyeballs are intact. No intraconal or extraconal space mass is identified. The extraocular muscles are intact. The lacrimal glands are symmetric and within normal limits in size and configuration. There is no optic nerve enhancement appreciated. The suprasellar cistern is intact . There is disconjugate gaze present.The small and subtle enhancing focus adjacent to the right midbrain at the expected location of the origin of the right oculomotor nerve is less conspicuous on the current exam. It is better seen on the coronal post gadolinium axial SPGR images (series 1701 image 48). It can also be seen on 3D FIESTA - image 47 series 1401. It is abutting the medial division of the superior cerebellar artery. It is best seen when comparing to the 7/11/13 exam when it was more conspicuous.
The small lesion along the proximal portion of the right oculomotor nerve is barely visible on the current exam.