42-year-old male, NF 2, status post resection of schwannoma and meningioma. Evaluate for new tumor. The patient is experiencing weakness. Brain and internal artery canal MRI:There is a focus of enhancement within the left sylvian fissure which appears to correlate with vascular structures when compared to T2 and susceptibility techniques. Although not described previously, this was present and unchanged on the most recent comparison of 12/3/2015. When comparing to the oldest, outside MRI dated 4/2/2015 (from Freeport Memorial Hospital), it appears to have enlarged.Redemonstrated is a contrast-enhancing left acoustic schwannoma, filling the left IAC, extending to involve the vestibule and a portion of the proximal semicircular canals. The largest portion within the left cerebellopontine angle measures 12 mm. These findings are unchanged in appearance.Redemonstrated is a contrast-enhancing right acoustic schwannoma, filling the right porous acusticus, extending to involve the vestibule, semicircular canals, as well as the geniculate ganglion and the right facial nerve (extending along its entirety to the parotid gland). The largest portion within the right cerebellar pontine angle measures 28 mm, which is unchanged in size. There remains mass effect upon the adjacent pons, middle cerebellar peduncle, and cerebellum, however without associated edema and unchanged in extent.There is a dural based enhancing mass underlying the left rectus gyrus which extends inferiorly into the superior-most left ethmoid air cells and adjacent inferior frontal sinus, most likely representing a meningioma. Given differences in technique, there has been no significant interval change.Also redemonstrated are a few, very small foci of enhancing prominence along the falx, probably anteriorly, which are unchanged in appearance. These likely represent very small meningiomas. There are a few foci of T2 hyperintensity within the within the white matter, predominantly subcortical in location, without associated restricted diffusion. Encephalomalacia involving the lateral left cerebellar hemisphere is stable.The ventricles and sulci are normal in size. The cerebellar tonsils are in appropriate position. There are no parenchymal masses, mass effect or midline shift. The pituitary gland is normal in size. There is no evidence for intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. The right mastoid air cells are completely opacified by fluid intensity material, unchanged. There has been prior retinal banding.Cervical spine MRI:Redemonstrated are postsurgical changes of suboccipital craniectomy and resection of the posterior arch of C1. Laminoplasties are also noted from C3 to C6. Again seen are multiple enhancing lesions throughout the cervical spine including nodular intramedullary lesions involving the cervical cord within the medulla and at the C1 and C2 levels which may represent ependymomas, unchanged in appearance. These are associated with T2 hyperintensity.Enhancing masses seen involving the right C2 nerve root and a smaller one on the left compatible with schwannomas, unchanged.C2-C3: Enhancing left nerve root with mild expansion of the neural foramina likely represents a schwannoma. There is mild intraspinal extension without significant cord deformity. These findings are unchanged.C3-C4: No enhancing lesions. No spinal or neuroforaminal stenosis. These findings are unchanged.C4-C5: Expansile lesion involving the right neural foramen again seen with intraspinal extension and mild residual mass effect on the right aspect of the cord. Partial resection as described previously. T2 hyperintensity within the right aspect of the cord. These findings are unchanged. C5-C6: Large, predominantly extraforaminal lesion on the right. Small enhancing extra foraminal lesion on the left. No spinal canal stenosis. These findings are unchanged. Previously demonstrated heterogeneous enhancement, posterior to the thecal sac has decreased in conspicuity. Indentation upon the posterior cord is again noted, unchanged, and still without intrinsic cord signal abnormality.C6-C7: Small, predominantly extraforaminal enhancing lesions bilaterally without expansion of the foramina. No spinal canal stenosis. These findings are unchanged.C7-T1: Small predominantly enhancing extraforaminal enhancing bilaterally lesions without expansion of the foramina. No spinal canal stenosis. These findings are unchanged.There is a relatively large lesion involving the peripheral aspect of the right C6 nerve root extending to the brachial plexus, unchanged.Vertebral body heights are normal. Mild focal kyphotic angulation at the C5-C6 level is again seen appearing more exaggerated, although this may be positional.
1.There is a focus of enhancement within the left sylvian fissure which appears to correlate with vascular structures when compared to T2 and susceptibility techniques. Although not described previously, this was present and unchanged on the most recent comparison of 12/3/2015. When comparing to the oldest, outside MRI dated 4/2/2015 (from Freeport Memorial Hospital), it appears to have enlarged. This constellation of imaging features may suggest an aneurysm which is stable compared to last December, however enlarged when compared to the prior April. CTA or catheter directed angiography could better characterize this finding and confirm an aneurysmal etiology.2.Stable bilateral acoustic schwannomas.3.Stable presumed meningioma underlying the left rectus tremors.4.Stable probable small meningiomas involving the falx.5.The right mastoid air cells remain completely opacified by fluid intensity material. 6.Again seen are multiple enhancing lesions throughout the cervical spine including nodular intramedullary lesions involving the cervical cord within the medulla and at the C1 and C2 levels which may represent ependymomas, unchanged in appearance.7.C4-C5: Expansile lesion involving the right neural foramen again seen with intraspinal extension and mild residual mass effect on the right aspect of the cord with associated T2 hyperintensity, unchanged. 8.C5-C6: Previously demonstrated heterogeneous enhancement, posterior to the thecal sac has decreased in conspicuity. Indentation upon the posterior cord is again noted, unchanged, and still without intrinsic cord signal abnormality.9.The remaining stigmata of NF 2 within the cervical spine MRI are stable in appearance as described in detail above.