Assess for possible lesion in left optic nerve detected on brain MRI. Mass in the right parotid. Orbits: There is no evidence of intraorbital optic nerve lesions. The globes, lacrimal glands, extraocular muscles, and orbital fat are unremarkable. However, there is an infiltrative, enhancing mass that involves the right parotid and parapharyngeal spaces, with extension into the right jugular foramen and hypoglossal canals, projecting slightly into the cerebellomedullary junction. Brain: There is swelling and enhancement of the bilateral prechiasmatic and intracanalicular optic nerves, measuring up to 6mm on the left and 4 mm on the right. There are patchy foci of T2 hyperintensity within the brainstem, medial cerebellar hemispheres, and inferior left basal ganglia region. There is also a subcentimeter probable right peritrigonal perivascular space. There is no evidence of intracranial hemorrhage or acute infarct. There is prominence of the medial left middle cranial fossa subarachnoid space associated with mild deformity of the adjacent sphenoid bone. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact.
1. Findings compatible with small prechiasmatic and intracanalicular optic nerve gliomas, left larger than right, which can be associated with neurofibromatosis type 1.2. An infiltrative, transpatial right facial mass with extension into the right jugular foramen and hypoglossal canals may represent a peripheral nerve sheath tumor, such as a plexiform neurofibroma, which can be associated with neurofibromatosis type 1.3. Patchy foci of T2 hyperintensity within the brainstem, medial cerebellar hemispheres, and inferior left basal ganglia region may also represent stigmata of neurofibromatosis type 1. 4. Suggestion of mild left sphenoid dysplasia, which can be associated with neurofibromatosis type 1.Discussed with Dr. Baroody at 1:30 PM on 2/24/16.