Reason: pt with adenoid cystic carcinoma. Evaluate for brain metastasis History: headache, nausea The CSF spaces are appropriate for the patient's stated age with no midline shift. The patient is status post left temporal bone surgery and left parotid surgery. Some enhancing tissue at the surgical site was present on prior CT exams and is suspected to represent postoperative change.There is mild asymmetric enhancement along the left facial nerve compared to the right. Both left and right enhance to the same extent. The left look slightly thicker.No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.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 are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.
1.Some mild asymmetry in the enhancement along the left facial nerve may be related to postoperative change in the venous plexus but is non-specific. The possibility it represent early perineural spread cannot be excluded. Please correlate with clinical findings of the left facial nerve and if appropriate, a follow-up MRI would be helpful.2.The patient is status post left temporal bone surgery and left parotid surgery. Some enhancing tissue at the surgical site was present on prior CT exams and is suspected to represent postoperative change.3.No evidence for brain metastases.