63 years, Female, right CSF otorrhea. Evaluate brain. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. No intracranial mass or mass-effect. The ventricles are within normal limits in size and configuration. Minimal scattered foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with mild chronic small vessel ischemic changes. Partially empty sella is noted which can be seen as a normal variant but can be associated with intracranial hypertension in the appropriate clinical setting. Cerebellar tonsils are low-lying without clear evidence of Chiari I reformation. No abnormal parenchymal or meningeal enhancement. Major flow-voids are preserved.There is diffuse opacification of the right-sided mastoid air cells. There is osseous defect involving the right tegmen mastoideum and compatible with history of CSF leak. Osseous defect and better seen on recent outside CT from 2/2/2016 as well as prior temporal bone CT from 12/8/2010. Minimal if any protrusion of the brain parenchyma is seen through this right temporal defect. There is asymmetrically increased enhancement of the overlying dura which may be reactive. No edema or clear evidence of encephalomalacia in the right temporal lobe is evident.Thinning of the roof of the left middle ear is also suspected as well as undulation of the left lateral temporal bone surface as well as the left greater sphenoid wing, better appreciated on outside CT and suggesting arachnoid pits. There is minimal opacification of the left-sided mastoid air cells.
1. Diffuse opacification of the right mastoid air cells with osseous defect involving the right tegmen mastoideum, which is better seen on recent CT. There is evidence of a meningocele at this level. There is minimal if any protrusion of the brain parenchyma through this right temporal bone defect. Dedicated temporal bone MRI can be considered for higher resolution visualization of this region if clinically indicated. There is asymmetrically increased enhancement of the overlying dura which may be reactive. No parenchymal edema or clear evidence of encephalomalacia in the right temporal lobe or elsewhere is appreciated.2. There is undulated appearance the floor of the contralateral left middle cranial fossa including the left sphenoid and left temporal bones with suggestion of "arachnoid pits". There are areas of osseous thinning/dehiscence in the left tegmen tympani. These osseous findings are better appreciated on prior temporal bone CT. 3. Partially empty sella which can be normal variant but can also be seen with intracranial hypertension. 4. Minimal nonspecific left mastoid air cell opacification.