Female, 30 years old, with history of neurofibromatosis type I, presenting with low back pain, unable to stand for prolonged periods, prior tumor of the buttocks. Also presenting with migraines, strabismus, Chiari, double vision, with midbrain tumor. Brain:A T2 hyperintense nonenhancing lesion is evident within the midbrain measuring 21 x 18 mm in the axial plane (image 12 series 21) and up to 15 mm in the coronal plane (image 22 series 22). This lesion expands the midbrain to a mild degree and may cause some narrowing of the cerebral aqueduct. No significant interval change is seen when comparison is made to prior exams.A nonspecific 4 mm focus of T2 hyperintensity is seen within the right superior frontal gyrus. No other significant parenchymal signal abnormality is seen. No pathologic parenchymal or extra-axial enhancement is noted. There are no abnormal extra-axial fluid collections and no findings to suggest acute intracranial hemorrhage. The ventricular system remains within normal limits for size. The cerebellar tonsils descend 2 to 3 mm below the level of the foramen magnum. Although not a dedicated orbital examination, no definite lesions are seen within the orbits or along the optic apparatus. A 2 mm focus of hypoenhancement within the posterior pituitary is nonspecific and was probably present on the prior examination.Lumbar:There is a mild levocurvature of the lower lumbar spine. Sagittal alignment is otherwise unremarkable.Vertebral bodies are diffusely narrowed in the AP dimension but otherwise show normal morphology and signal characteristics. A transitional L5 vertebral body is noted.The visualized distal spinal cord and conus are unremarkable. The conus tip terminates at the L1 level which is within normal limits. The nerve roots of the cauda equina are evenly distributed through the thecal sac. Note is made of marked ectasia of the thecal sac in the sacral region with ectatic extension into the sacral foramina. No definite evidence of any foraminal or intracanalicular tumor is seen.No evidence of significant disc bulging or disc herniation is seen. Facet hypertrophy is noted at L4-5 and L5-S1. However, no significant spinal canal or neuroforaminal stenosis is seen at any level.Diffuse abnormal T2 signal is seen in the right gluteal region, partially visualized on this examination and perhaps related to prior surgery. Numerous cutaneous and subcutaneous nodules are evident compatible with neurofibromas.
1.A nonenhancing masslike lesion within the midbrain shows no significant interval change in size from prior exams. This lesion mildly expands the brainstem and may encroach upon the cerebral aqueduct, though the ventricular system remains within normal limits. The cerebellar tonsils are mildly low-lying, similar to prior.2.Elsewhere in the brain, no concerning lesions are seen. A nonspecific focus of signal abnormality is unchanged in the right superior frontal gyrus. Likewise, a nonspecific focus of hypoenhancement in the posterior pituitary was evident on prior examinations and can be better assessed with dedicated imaging if clinically warranted.3.Marked ectasia of the thecal sac is seen in the region of the sacrum, similar to prior.4.No evidence of any intracanalicular or foraminal tumor is seen. No significant compromise of the spinal canal or neural foramina is noted.