Reason: resolution of meningeal enhancement? History: headaches The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a mild degree of periventricular and subcortical confluent hyperintense white matter lesions present identified on the FLAIR and T2 images. Some of these signal changes extend into the thalami and midbrain are additional confluent signal hyperintensities are present in the deep white matter of the cerebellum. When compared to the previous exam these white matter signal hyperintensities have progressed.Since the prior exam right-sided leptomeningeal vascular enhancement has mildly regressed but has not resolved.There are small foci of enhancement present on the prior exam the right middle frontal gyrus and right parietal lobe which are not as conspicuous on the current exam.No abnormal enhancing mass lesions are appreciated intracranially. 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 demonstrates a bright signal within the left eyeball.Incidental note is made of empty sella.
1.There is continued progression of diffuse white matter, thalamic, brainstem and deep cerebellar signal change. Etiology is uncertain.2.Since the prior exam leptomeningeal intravascular enhancement - suspected to be related to collateral flow - has a regressed. This change is non-specific. The patient is known to have a occlusion of the right middle cerebral artery.3.Ocular abnormalities are present. Please correlate with visual exam findings and history.