Worsening of meningoma causing compression: TIA symptoms. Brain MRI: There is an area of restricted diffusion and high T2 signal in the right frontal lobe that measures up to 20 mm. There are also punctate foci of restricted diffusion in the left frontal lobe. There is a background of chronic lacunar infarcts in the left postcentral gyrus, bilateral basal ganglia, and right corona radiata, as well as scattered foci of cerebral white matter T2 hyperintensity without restricted diffusion. There is a punctate focus of susceptibility effect in the right periventricular white matter, which may represent a chronic microhemorrhage. There is an enhancing, dural-based mass in the left cavernous sinus region, with extension into the left orbital apex, sella, and sphenoid sinus, measuring up to approximately 50 mm overall. There appears to be compression of the left optic nerve. There are postoperative findings related to left pterional craniotomy with left anterior temporal lobe encephalomalacia. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. Brain MRA: There is significant loss of flow related enhancement in the left internal carotid artery, with reconstitution distally at the circle of Willis. There may also be mild narrowing of the ophthalmic segment of the right internal carotid artery. There is no evidence of significant steno-occlusive lesions involving the rest of the intracranial arteries. There is no evidence of cerebral aneurysms.Neck MRA: There is relatively diminished enhancement of the left internal carotid artery attributable to downstream compromise of the vessel. There is otherwise no evidence of significant steno-occlusive lesions in the neck arteries.
1. Bilateral frontal lobe recent infarcts, right larger than left, without hemorrhagic transformation or midline shift, superimposed upon chronic lacunar infarcts and small vessel ischemic disease.2. Left cavernous sinus region meningioma with significant compression of the intracranial left internal carotid artery.3. No evidence of significant steno-occlusive cervical artery lesions.