Female, 36 years old, with headache and left eye pain. A punctate focus of restricted diffusion is seen within the left superior parietal lobule. No other definite restricted diffusion is seen. However, there are numerous scattered punctate foci of white matter T2 hyperintensity, none of which is associated with significant edema or mass effect.Brain parenchymal morphology is otherwise unremarkable. No acute intracranial hemorrhage or any abnormal extra-axial fluid collection is seen. No pathologic parenchymal or extra-axial enhancement is observed. The ventricles are normal in size and morphology. The pituitary region is unremarkable. Asymmetric prominence of the left basal vein of Rosenthal and deep middle cerebral vein is noted.Assessment of the orbits is somewhat compromised by motion artifact and poor fat saturation. Within this limitation, no definite evidence of any optic nerve or extraocular muscle abnormality is seen. The globes are round and symmetric. The superior ophthalmic veins are not dilated.The left petrous apex is fluid-filled and shows mild streaky enhancement as well. There may be slight thickening of the adjacent middle cranial fossa dura, but this is equivocal. No definite abnormalities of the cavernous sinus are noted. The mastoid air cells and middle ear cavities as visualized on this examination are unremarkable.
1.A punctate focus of restricted diffusion is seen within the left superior parietal lobule. In addition, there are numerous scattered punctate foci of T2 hyperintensity throughout the cerebral hemisphere. These findings could represent lesions related to migraine headache or some other vasculitic process with the lesion in the left parietal lobe being relatively more acute.2.Asymmetric prominence of the left basal vein of Rosenthal and deep middle cerebral vein are of uncertain significance and may simply represent normal anatomic variation. No other findings to suggest a vascular shunting lesion are seen.3.Given reduced image quality as above, no definite intraorbital abnormalities are appreciated. However, the left petrous apex is fluid-filled and demonstrates mild streaky enhancement. This could represent mild or resolving petrous apicitis, a diagnosis which could account for the patient's left eye pain.