Known brain lesion and history of neurofibromatosis type 1. There is an infiltrative T2 hyperintense, non-enhancing, mildly expansile lesion centered within the pons with extension into the medial left cerebellum and medulla. There is diffuse leptomeningeal enhancement within the posterior fossa, particularly within along the brainstem. There is also a non-enhancing, rounded, subcentimeter, T2 hyperintense, subcortical lesion in the lateral left occipital lobe. There are also punctate non-enhancing T2 hyperintense foci in the white matter of the bilateral parietal lobes. There is coaptation of the right lateral ventricle frontal horn. Otherwise, the lateral and third ventricles are borderline prominent. There is no evidence of acute infarction or hemorrhage. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits are grossly unremarkable. There are several punctate enhancing nodules in the scalp.
1. An infiltrative lesion within the pons with extension into the medial left cerebellum and medulla and regional leptomeningeal enhancement may represent a neoplasm, such as a low-grade glioma in the setting of neurofibromatosis versus less likely an infectious or inflammatory process. 2. A subcentimeter subcortical lesion in the lateral left occipital lobe and small white matter lesions in the bilateral parietal lobes may also represent manifestations of neurofibromatosis.3. Several punctate enhancing nodules in the scalp may represent neurofibromas. Discussed with Dr. Awad at 9:30 AM on 1/20/16.