Meningioma. Brain: There are multiple foci of restricted diffusion in the left parietal lobe and to a lesser degree left posterior frontal, left posterior temporal and left occipital lobes. There are areas of associated T2/FLAIR hyperintensity as well as T1 hyperintensity reflecting laminar necrosis, which are new since prior from 3/12/2016. There are also areas of associated parenchymal enhancement. Findings are consistent with acute and subacute infarcts. There is also cortical volume loss in the left parietal lobe likely reflecting chronic infarct, but new since prior. There is no associated mass effect or evidence of hemorrhagic confirmation.Multiple additional scattered chronic infarcts including the right temporal parieto-occipital lobes as well as the right postcentral gyrus and left paramedian pons are again seen. There is T2 hyperintensity along the middle cerebellar peduncles, likely reflective of Wallerian degeneration. Additional nonspecific scattered T2/FLAIR hyperintense foci are compatible with small vessel ischemic disease.There is no appreciable change in the enhancing dural-based mass centered in the right cavernous sinus region that measures up to approximately 25 mm in the AP dimension There is mild extension into the right prepontine cistern posteriorly as well as extension into the right middle cranial fossa inferiorly. Tumor extends to fill the right Meckel's cave. There also appears to be intrasellar extension. There is no midline shift or herniation. No hydrocephalus. The flow-voids of the cavernous internal carotid arteries are somewhat diminutive as is the right vertebral artery flow-void. Arterial stenoses are better assessed on prior CTA from 12/4/2015.Orbits: There is no evidence of intraorbital mass lesions or abnormal enhancement. The bilateral globes, lacrimal glands, optic nerves, and extraocular muscles are unremarkable. Optic chiasm is also unremarkable.
1. Multiple acute and subacute infarcts in the left parietal lobe and to a lesser degree in the left temporal, occipital, and posterior frontal lobes. Additional chronic infarcts including the right cerebral hemisphere and left pons are also again evident.2. No significant change in right cavernous sinus meningioma.3. Arterial stenosis better assessed on prior CTA from 12/4/2015.Dr. Ali discussed findings of infarcts with Dr. Reeti Greenwald (neurology) at noon on 9/21/2016.