Male 68 years old Reason: evidence of metastasis, inflammation History: left facial numbness. There is no evidence of intracranial hemorrhage or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There are a few scattered areas of nonenhancing T2/FLAIR hyperintensity in the subcortical white matter which are nonspecific but may be related to chronic small vessel ischemic disease. There is a asymmetric is prominent enhancement in the expected location of the right geniculate ganglion, as well as asymmetric enhancement and thickening of the mastoid segment of the right seventh cranial nerve. There is asymmetric enhancement and prominence of the left V3 nerve just distal to Meckel's cave. There is no abnormal enhancing mass within the brain parenchyma. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. Small lipoma along the left frontal scalp.
1.Abnormal asymmetric enhancement in the right geniculate ganglion and left V3 segment of the trigeminal nerve. Isolated metastatic disease to these locations would be unusual without evidence of other intracranial leptomeningeal involvement. Differential includes granulomatous, infectious, and other inflammatory causes. Lymphoma is also considered. Recommend follow-up dedicated trigeminal nerve MRI protocol to further evaluate. 2.No evidence of enhancing intraparenchymal mass to suggest metastatic disease to the brain. 