 There is an unchanged lesion centered in the right petrous apex with high T2 and low T1 signal and thinning of the overlying cortex. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are unchanged T2 hyperintense foci compatible with chronic small vessel ischemic disease. There is also left medial temporal lobe encephalomalacia with hemosiderin staining. There is a partially-empty, expanded sella. The ventricles and basal cisterns are symmetric in size and configuration, and unchanged over several examinations. There is no midline shift or herniation. The orbits paranasal sinuses, and scalp soft tissues are grossly unremarkable.MRA
1. Unchanged lesion centered within the right petrous apex for which the differential diagnosis includes an effusion/early mucocele, cephalocele or prominent arachnoid granulation, and less likely neoplasm, such as low grade chordoid matrix tumor.2. Unchanged subcentimeter left MCA bifurcation and right PCOM aneurysms.3. Unchanged probable microangiopathic white matter disease and hypertensive microhemorrhages, as well as left medial temporal lobe encephalomalacia with prior hemorrhage.4. Partially-empty, expanded sella, which can be a manifestation of pseudotumor cerebri. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.