 Orbits: Previously seen multiple small enhancing lesions involving the bilateral extraocular muscles have resolved. Small enhancing lesion involving the right frontal scalp appears decreased in conspicuity although there remains mild residual enhancement in this region. Small lesions in the right infratemporal fossa and left masticator space also appear to have resolved. Previously seen enhancing lesion in the right malar region is no longer definitively appreciated although there is artifact in this region on the current study which limits assessment. No new lesions. Bilateral globes and retrobulbar fat are unremarkable. Bilateral optic nerves are normal in signal.Brain: No evidence of intracranial mass or parenchymal edema. No abnormal parenchymal or meningeal enhancement. No extra-axial collections. Ventricles and sulci are within normal limits.There are punctate foci of susceptibility in the left cerebellar hemisphere as well as the right posterior paramedian frontal lobe. The left cerebellar focus was present previously. The right posterior frontal focus was not definitively present on prior study although this may reflect technique differences.There are frothy secretions within the left maxillary sinus as seen on recent CT. There is also mucosal thickening involving the left frontal sinus and mild bilateral ethmoid opacification. There is overall improvement in paranasal sinus opacification since recent CT from 12/3/2016.There is mild opacification of the bilateral mastoid air cells which is new since prior MRI from 9/23/2016.
1. There is no evidence of active infection or leukemia involving the brain.2. There are two punctate foci of susceptibility effect in the right posterior frontal lobe and in the left cerebellum. These may represent chronic microhemorrhages or mineralization and although nonspecific may represent sequela of treated infection.3. Images of the orbits demonstrate interval resolution of the previously seen small enhancing lesions in the extraocular muscles. Additional lesions involving the maxillofacial soft tissues have also resolved or nearly resolved. Please see additional comments above.