Multiple myeloma with metastatic disease: headache. There is an enhancing lesion within the clivus, eccentric tot the left, which measures up to approximately 30 mm. There is perhaps slight epidural extension. There is also an enhancing lesion in the right sphenoid triangle, which measures up to approximately 15 mm, with extraosseous extension. In addition, there is an enhancing lesion right parapharyngeal space and pterygoid process that measures up to 20 mm. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. 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. The orbits are grossly unremarkable. There are bilateral maxillary sinus retention cysts and probable mild mucosal thickening in the posterior left sphenoid sinus.
1. Lesions in the clivus, right sphenoid triangle, and in the right parapharyngeal space and pterygoid process are compatible with multiple myeloma.2. No evidence of intracranial hemorrhage, mass, or acute infarct. 