Reason: r/o R ethmoid sinus herniating encephalocele seen on MRI There is a focal 9-mm defect along the right ethmoid sinus roof with apparent herniation of a small focal portion of the inferior right frontal lobe cortex into the defect. There is associated T2 signal change in the immediately adjacent cortex. The right olfactory and medial orbital sulci are effaced.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.The pituitary fossa is enlarged and deformed. The right lobe of the pituitary is asymmetrically larger than the left.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 demonstrate mucosal thickening in the left maxillary and ethmoid sinuses which has improved since the prior exam. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.
1.Findings suggest a small encephalocele along the anterior cranial fossa extending into the ethmoid air cells. The patient will be brought back to obtain additional Coronal 3D Fiesta and coronal T2 2mm thin slices through the anterior cranial fossa which were not done and will be part of this study.2.The pituitary gland is asymmetrically enlarged along its right lobe.3.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related. 