53 years Male (DOB:8/17/1962)Reason: new right ptosis and swelling, evaluate cranial nerves 3-6 History: as abovePROVIDER/ATTENDING NAME: JONAS ARAUJO DE SOUZA JONAS ARAUJO DE SOUZA There is a heterogeneous lesion present in the right cingulate gyrus and adjacent to right paracentral lobule associated with the foci of susceptibility effect and local volume loss. It is associated with some foci of T1 signal hyperintensity Axial dimensions of the FLAIR signal abnormality are approximately 54 x 28 mm axial dimensions. On coronal T2 imaging measures approximately 34 x 27 mm coronal dimensions. On the prior exam from 3/15/2016 measured approximately 33 x 63 mm axial dimensions Another heterogeneous lesion is present in the right basal ganglia which measures 20 x 26 mm axial dimensions. This was larger on the prior exam. It is associated with some foci of T1 signal hyperintensityThere is a 3 mm T2 hyperintense lesion associated with susceptibility effect located in the left caudate nucleus which remains stable compared to the prior exam. It is associated with T1 signal hyperintensity.A small focus of susceptibility effect is present along the left occipital lobe lingual gyrus adjacent to the calcarine sulcus anteriorly. It is stable compared to the prior exam.A punctate focus of T2 and FLAIR hyperintensity is present in the right thalamus stable. It is associated with susceptibility effect.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.Some of the images are degraded due to patient motion as well as by motion. Many of the imaging sequences were repeated.
1.Since the previous examination lesions located in the right basal ganglia and right cingulate gyrus have regressed in overall size predominantly due to regression of edema.2.Small lesions in the left caudate nucleus, right thalamus and the left occipital lobe are stable.3.Although no cranial nerve lesion is identified contrast-enhanced MRI exams or more sensitive in identifying cranial nerve lesions when compared to noncontrast exams.4.Please note that contrast-enhanced exams or more sensitive in detecting recurrent tumor.5.The patient had difficulty cooperating with the exam and as a result the examination was not completed as intended ( with contrast and with more imaging specific to the cranial nerves)