Diagnosis: Headache(784.0)Clinical question: pain behind right eyeSigns and Symptoms: pain behind right eye MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.There is a cystic-appearing extra-axial mass present measuring 18 x 13 mm axial dimensions which is underneath and adjacent to the left inferior temporal gyrus and abuts the petrous portion of the temporal bone it is somewhat heterogeneous on T2 imaging but it is low signal on FLAIR imaging and low signal on T1-weighted imaging is suspected to be associated with the lumen of susceptibility effect. It appears to be covered by dura. There also appears to communicate with the left temporomandibular joint. Incidental note is made of some hypertrophic changes at the left temporomandibular jointThere is a 18 x 7 mm coronal dimension sessile extra-axial lesion present which is adjacent to the right parietal lobe. It is associated with diffusion restriction.No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. The eyeball lenses are thin.MRI cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. The patient is status post anterior fusion at C5-6.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina. There are small uncovertebral osteophytes present at this level associated with some disc material and mild narrowing of the neural foramina.At C4-5 there is no significant compromise to the spinal canal or neural foramina. There are uncovertebral osteophytes present on the right side at this level with some narrowing of the right neural foramen.At C5-6 there is no significant compromise to the spinal canal or neural foramina.At C6-7 there is no significant compromise to the spinal canal or neural foramina. There is a disc bulge present at this level.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.Small lesions are suspected present in the left upper mediastinum which are bright signal on T2 STIR imaging. The adjacent to each other one measures 10 x 14 mm sagittal dimensions and the other measures 9 x 12 mm sagittal dimensions. This is not completely imaged on this exam. It's possible that may represent lymph nodes at the upper limits of normal in size.
1.There is a small extra-axial mass present adjacent to the right parietal lobe. It most likely represents a meningioma. It does not compress the underlying brain.2.There is a small complex cystic extra-axial lesion adjacent to the left temporal lobe. If clinically appropriate MRI of the brain with gadolinium may be of further benefit in evaluating this since it does have a somewhat complex appearing component. Its proximity to the left TMJ may suggest a relationship with this such as a ganglion cyst or synovial chondromatosis. Another possibility is that it represents a cystic meningioma. It is atypical for an arachnoid cyst.3.There are multilevel degenerative changes present in the cervical spine but no significant compromise to spinal canal or exiting nerve roots. The patient is status post anterior fusion at C5-6.4.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.5.There are degenerative changes present in the left temporomandibular joint that are not completely imaged on this exam and appear to be adjacent to the cystic lesion identified next to the temporal lobe. If clinically appropriate CT or plain film imaging of the temporomandibular joint may be of benefit.6.Nodules in the left upper mediastinum are incompletely imaged on this exam and may represents lymph nodes but are not adequately imaged for a more conclusive interpretation. This would represent an incidental finding.7.Findings were discussed with Dr. HEKMATPANAH at 11:30 on 7/6/15. 