64 years, Female, Reason: NF1 History: unsteadiness. Brain: No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. No intracranial mass or mass-effect. There is global parenchymal volume loss slightly prominent for age. Encephalomalacia is also noted involving the left inferior cerebellar hemisphere as well as evidence of chronic infarct involving the left dorsal medulla. There is small focus of gliosis involving the left anterior aspect of the gyrus rectus. Focus of cortical encephalomalacia is also noted in the left anterior temporal lobe. There is susceptibility effect compatible with chronic blood products involving the foci in the left inferior frontal lobe and the left cerebellum compatible with chronic hemorrhage. Several additional foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with chronic small vessel ischemic disease and stable to minimally progressed since 6/8/2009.. No abnormal parenchymal or meningeal enhancement. Major flow-voids are preserved. Prominent enhancing soft tissue is noted involving the suboccipital and upper cervical posterior paraspinous soft tissues which may represent a large neurofibroma or perhaps enhancing soft tissue related to prior surgery if there is such history. There is susceptibility artifact related to previously seen coiled embolization involving the left vertebral artery aneurysm at the C1 level.There appears to be enlargement involving the left optic nerve which is not well evaluated but grossly similar to 6/8/2009. Minimal mucosal thickening in the paranasal sinuses.Cervical spine: There is evidence of dural ectasia with scalloping involving the dorsal aspect of the cervical vertebral bodies. There are degenerative changes with small disc osteophyte complexes, relatively more prominent at the C3-C4, and C5-C6 levels, with no evidence of spinal canal stenosis at any level. Differences in technique limit comparison however there is stable to slight enlargement of T2 signal abnormality involving the dorsal aspect of the cervical cord in the midline at the C4-C5 level compared to 6/8/2009. Unchanged exaggerated lordosis of the cervical spine.Left vertebral artery flow-void is severely diminished with evidence of stenosis and prior coil embolization for aneurysm better assessed on prior CT angiogram.No appreciable masses involving the cervical spinal canal or neural foramina to suggest neurofibromas.Multiple small neurofibromas involving the subcutaneous soft tissues are seen with the large lesion extending from the suboccipital soft tissues to the lower C2 level. There is mild right-sided neural foraminal narrowing at the C5-C6 level.
1. Again seen is evidence of multiple infarcts including the left cerebellum and left dorsal medulla with additional areas of cortical injury involving the left inferior frontal lobe and left anterior temporal lobe. There is also evidence of chronic small vessel ischemic disease which appears stable to minimally progressed since 6/8/2009. No evidence of acute infarct or intracranial mass effect.2. Suspected mild enlargement of the left optic nerve which appears to be present on prior studies. This finding is not well evaluated on this brain MRI study however given history of NF 1 raises suspicion for an optic glioma. Dedicated orbital MRI may be considered for better assessment if clinically indicated.3. Stable to slight enlargement of nonenhancing T2 cord signal involving the cervical cord at the C4-C5 level in the midline compared to 6/8/2009. Finding may represent sequela of prior injury but is nonspecific. No masses involving the cervical spinal canal or neural foramina to suggest neurofibromas. No evidence of spinal canal stenosis at any level.4. Prominent enhancing soft tissue involving the suboccipital and upper cervical posterior paraspinous soft tissues presumably representing a neurofibroma and similar to prior from 2009. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.