Unexplained left optic nerve atrophy History: 76 year old female with unexplained left optic nerve atrophy. Orbits: There is diffuse atrophy of the left optic nerve. There appear to be There is a defect in the lower right lamina papyracea with mild herniation of orbital far. There is also deformity of the right medial rectus muscle, with a linear projection directed. There are bilateral lens implants. There is no evidence of intraorbital mass lesions.Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is a focus of encephalomalacia in the left thalamocapsular junction region with associated susceptibility effect. There is diffuse patchy cerebral white matter T2 hyperintensity bilaterally. There is diffuse cerebral volume loss. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull and scalp soft tissues are grossly unremarkable. There is mild mucosal thickening in the left maxillary sinus.
1. Diffuse left optic nerve atrophy without evidence of compressive lesions. This may be related to chronic ischemic disease, for example.2. Chronic right lamina papyracea fracture.3. Chronic hemorrhagic lacunar infarct in the left thalamocapsular junction superimposed upon a background of probable chronic small vessel ischemic disease, but no evidence of acute infarction.