Male, 54 years old, with history of multiple myeloma, as well as herpes zoster, with confusion and unsteady gait. Assess lytic lesions and mass described on recent CT. Also evaluate for CNS myeloma involvement and CNS herpes zoster. Bone marrow signal characteristics are diffusely heterogeneous including both the calvarium and the visualized upper cervical spine.An enhancing mass is centered on the floor of the right middle cranial fossa with both intracranial and extracranial components measuring up to 21 mm in thickness. This lesion indents the adjacent anterior temporal lobe, but the interface between brain and tumor remains smooth and there is no evidence of parenchymal enhancement or edema to suggest brain invasion at this time.Numerous additional smaller areas of pathologic marrow enhancement are seen, none of which is associated with any large or significant intracranial or extracranial components.The dura along the bilateral convexities and along the right temporal bone is mildly and smoothly thickened, likely a reactive phenomenon to the overlying bony disease.No areas of pathologic parenchymal enhancement are seen. No parenchymal edema is detected. Mild periventricular T2 hyperintensities are a nonspecific finding. Diffusion weighted images are within normal limits.No abnormal extra-axial fluid collections are seen. No evidence of intracranial hemorrhage is detected. The ventricular system is normal in size and morphology.The skin of the right frontal and periorbital regions may be slightly edematous but this is an equivocal finding.
1.Diffuse abnormality of the bone marrow compatible with the stated history of multiple myeloma.2.A localized tumor deposit is evident centered on the floor of the right middle cranial fossa. This lesion has both extracranial and intracranial components. The intracranial component indents the adjacent anterior temporal lobe but without clear evidence of brain invasion.3.Smooth dural thickening likely reflects a reactive process to the overlying bony disease. No additional areas of significant intracranial tumor are suspected.4.No specific findings are seen to suggest active herpetic encephalitis or other acute abnormalities.