Clinical question: Evaluate for intracranial mass or orbit, history of thyroid disease. Signs and symptoms: Biocullar diplopia. Pre-and post-enhanced brain MRI:No diffusion weighted abnormalities. Flair and T2-weighted images demonstrate few small foci of hyperintensity in the subcortical and periventricular white matter, left basal ganglia and pons which are nonspecific and non-hemorrhagic and without detectable abnormal enhancement. Considering patient's provided age of 75 this appearance is suggestive of chronic small vessel ischemic strokes of mild degree. The cortical sulci, ventricular system, CSF spaces and myelination the brain is otherwise unremarkable and with normal signal intensity on all MRI sequences. There is no evidence of abnormal enhancement the brain parenchyma or leptomeninges on is a diffuse series.Calvarium demonstrate normal signal intensity and without abnormal enhancement.Unremarkable images through the orbits and including axial fat sat post enhanced series.Signal void of major intracranial arterial branches are identified.Intracranial venous sinuses demonstrate normal pattern of enhancement.Pre-and post enhanced MRI orbits:Shin demonstrate normal signal intensity of retro-orbital fat without abnormal enhancement.Normal signal intensity, size and pattern of enhancement the extraocular musculature.Normal signal intensity and size of bilateral optic nerves in the retro-orbital spaces and in their cisternal segment without abnormal enhancement.Normal signal intensity and morphology of globes without abnormal enhancement.Normal signal intensity and pattern of enhancement of bilateral cavernous sinuses.
1.Pre-and post enhanced brain MRI demonstrate no acute intracranial findings. Findings suggestive of mild chronic small vessel ischemic strokes as detailed and unremarkable exam otherwise. No detectable abnormal enhancement of brain parenchyma, leptomeninges, calvarium orbits protocol spaces.2.Unremarkable pre-and post enhanced MRI of orbits.3.Diffuse mild chronic because of thickening and postoperative changes of bilateral endoscopic functional sinus surgery. 