62 years, Female, proximal weakness. Evaluate for transverse myelitis. Diplopia. BRAIN
1. There is abnormally increased enhancement along the surface of the cervical and thoracic cord and possibly also along the surface of the brainstem and proximal trigeminal nerves favored to be related to leptomeningeal inflammation or infection, less likely neoplasm. There is also suggestion of minimal intramedullary signal abnormality and enhancement at the T3-T4 level where the dorsal leptomeningeal enhancement along the surface of the cord is more prominent and demonstrates mild nodularity. Leptomeningeal neoplasm seems less likely but not excluded. Suggest lumbar puncture for further assessment. 2. There are postoperative changes of left sided vestibular schwannoma resection with grossly stable enhancement in the left internal auditory canal which may represent postoperative change or grossly stable minimal residual tumor. High-resolution MRI IAC can be considered for more detailed evaluation if clinically indicated. Images of the brain demonstrate no acute hemorrhage, infarct, or mass effect.3. No significant spinal canal stenosis in the cervical or thoracic spine to suggest extrinsic compression. 