7-year-old male with neurofibromatosis type I, assess for change of known brainstem tumor or optic glioma. Patient is experiencing headaches. MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. There is redemonstration of an infiltrative mass at the cervicomedullary junction associated with mass effect. It is predominantly high signal on T2 and low signal on T1. Given slight differences in level of slice acquisition, this is unchanged in size or morphology. Associated patchy contrast enhancement has has decreased, especially along its left lateral aspect.There is a redemonstration of a T2 signal hyperintense lesions located in the bilateral cerebellar gray nuclei as well as the thalami and basal ganglia which were also present on the prior exam and not substantially changedNormal 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.Mucosal thickening can be found throughout the paranasal sinuses, with complete obstruction of the left maxillary sinus. The visualized portions of the mastoid air cells are clear.MRI orbits:Redemonstrated is hypothalamic enlargement, unchanged in morphology, however demonstrating a new subtle focus of enhancement just superior to the junction with the pituitary stalk (best seen on image 3, series 3901).Redemonstrated is a small 3-mm T2 hyperintense, enhancing mass with hypointense center immediately inferior to the left optic nerve in the region of the left orbital apex, unchanged in appearance. Orbits and globes are otherwise unremarkable. The optic chiasm is normal. Optic tracts appear unremarkable. Cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. Redemonstrated is enlargement of the central canal in the upper thoracic spine not entirely included on this exam.No abnormal enhancing lesions are appreciated in the cervical cord.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is a left-sided nerve sheath lesion associated with patchy contrast enhancement. It is associated with enlargement of the adjacent neural foramen. These findings are unchanged.At C4-5 there is a left-sided nerve sheath lesion which is stable compared to the prior exam. It is associated with patchy contrast enhancement and slight flattening of the left lateral cord. It is associated with enlargement of the adjacent neural foramen.At C5-6 there is no significant compromise to the spinal canal or neural foramina.At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.
1.There is an infiltrative mass at the cervicomedullary junction associated with mass effect. It is predominantly high signal on T2 and low signal on T1. Given slight differences in level of slice acquisition, this is unchanged in size or morphology. Associated patchy contrast enhancement has has decreased, especially along its left lateral aspect.2.T2 signal hyperintense lesions located in the bilateral cerebellar gray nuclei as well as the thalami and basal ganglia have not substantially changed.3.Redemonstrated is hypothalamic enlargement, unchanged in morphology, however demonstrating a new subtle focus of enhancement just superior to the junction with the pituitary stalk (best seen on image 3, series 3901).4.There is a small 3-mm T2 hyperintense, enhancing mass with hypointense center immediately inferior to the left optic nerve in the region of the left orbital apex, unchanged in appearance.5.Redemonstrated is enlargement of the central canal in the upper thoracic spine not entirely included on this exam.6.At C3-4 there is a left-sided nerve sheath lesion associated with patchy contrast enhancement, unchanged.7.At C4-5 there is a left-sided nerve sheath lesion associated with patchy contrast enhancement and slight flattening of the left lateral cord, unchanged.