Clinical question: assess for mass lesions, intracranial vasculitis, spinal cord lesionSigns and Symptoms: headache, vision loss, Unqualified visual loss, left eye, normal vision right eye. Unqualified visual loss, left eye, normal vision right eye; Headache. Upper extremity hyper-reflexia, neck pain. Cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. There is reversal of the normal cervical curvature present.No abnormal enhancing lesions are appreciated in the cervical spine.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina. There are small uncovertebral osteophytes present at this level. There is a small central disk protrusion present at this level.At C4-5 there is no significant compromise to the spinal canal or neural foramina. There is a disk bulge present at this level. There are small uncovertebral osteophytes present at this level. At C5-6 there is no significant compromise to the spinal canal or neural foramina. There are uncovertebral osteophytes present at this level associated with disk material and mild encroachment of the right sided exiting nerve roots.At C6-7 there is no significant compromise to the spinal canal. There is a left lateral recess disk protrusion at this level encroaching on the left sided exiting nerve roots. There are left sided endplate reactive changes present at this level with irregular end-plates.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.MRA brain:There is a 2.5 mm medially directed aneurysm along the proximal portion of the opthalmic segment of the left internal carotid artery.Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.There is extracranial origin of the left PICA which is not entirely included on this exam.MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal foci of contrast enhancement are present in the brain parenchyma.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.A small lesion in the left cerebellar hemispheres along the inferior semilunar lobule follows CSF on all pulse sequences .There is focal atrophy of the left middle frontal gyrus.No abnormal enhancing mass lesions are appreciated within the brain parenchyma. 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 are intact.There is a well circumscribed 10x7 mm focus of marrow replacement in the left parietal bone just posterior to the coronal suture and superior to the squamous temporal bone which enhances following gadolinium administration.Incidental note is made of choroid plexus xanthogranulomas.MRI orbits:There is T2 signal hyperintensity along the right optic nerve without associated contrast enhancement. This is associated with a smaller right optic nerve compared to the left optic nerve which is more obvious on the cisternal segment.The eyeballs are intact. No intraconal or extraconal space mass is identified. The extraocular muscles are intact. The lacrimal glands are symmetric and within normal limits in size and configuration. There is no optic nerve enhancement appreciated. The suprasellar cistern is intact .
1.There is a 2.5 mm left opthalmic segment aneurysm present.2.There is a small right calvarial lesion present which in isolation is non-specific. In the appropriate clinical settings it is possible that it is related to neoplasia or sarcoidosis (as was suggested in the clinical history of the chest x-ray report) for example. Please correlate with clinical history. If appropriate a follow-up with CT of the head may be helpful. Alternatively a bone scan may help evaluate for metastases in the appropriate clinical setting.3.There is a left lateral recess disk protrusion at C6-7 encroaching on the left sided exiting nerve roots.4.T2 signal hyperintensity and atrophy along the right optic nerve is a non-specific finding. One possibility is that this is related to degeneration/atrophy of the nerve or 5.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related. 6.Focal atrophy within a portion of the left middle frontal gyrus.7.A small lesion in the left cerebellar hemispheres along the inferior semilunar lobule likely represents an enlarged perivascular space (possibly related to remote ischemic injury).8.Although there is no evidence for vasculitis on this exam, this diagnosis cannot be excluded based on this exam alone.