Disorder of trigeminal nerve, unspecified. Neoplasm of uncertain behavior of central nervous system, unspecified. Disorder of facial nerve, unspecified Sixth (abducent) nerve palsy, unspecified eyeDiagnosis Edits: |||Clinical question: Outside Request: known R. Cavernous sinus lesion w/ext. along R. infraorbital nerve; clinically has R. V, VI, VIII CN palsies, please do high resolution imaging of intra-/extracranial course of CNs V, VI, VII MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. 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.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. Additional T2 and FLAIR hyperintense patchy lesions are present in the brainstem. These are all stable when compared to the prior examSeveral punctate hypointense foci are present in the periventricular white matter on susceptibility weighted imaging.There is no abnormal enhancement appreciated along the course of the seventh cranial nerve.The visualized portions of the paranasal sinuses demonstrate a mucous retention cyst in the left maxillary sinus. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. The eyeball lenses are thin.MRI cavernous sinuses:An infiltrating lesion is present along the lateral aspect of the right cavernous sinus which extends into the right foramen of volume as well as the right foramen rotundum and the right superior orbital fissure. The extent of the lesion is stable and compared to the June exam.There is new enhancement of the right trigeminal nerve along its cisternal segment and Meckel's cave.There is enhancement and thickening of the nerve root within the foramen rotundum and foramen ovale as well as nerve roots coursing the right superior orbital fissure.MRI orbits:An infiltrating lesion is present along the lateral aspect of the right cavernous sinus which extends into the right foramen of volume as well as the right foramen rotundum and the right superior orbital fissure. The lesion does appears to involve the Meckel's cave and the cisternal segment of the trigeminal nerve. There is enhancement and thickening of the nerve root within the foramen rotundum and foramen ovale as well as nerve roots coursing the right superior orbital fissure.The eyeballs are intact. No intraconal or extraconal space mass is identified. The extraocular muscles are intact. The lacrimal glands are symmetric and within normal limits in size and configuration. There is no optic nerve enhancement appreciated. The suprasellar cistern is intact .
1.Findings suggest interval progression of an infiltrating lesion centered along the lateral aspect of the right cavernous sinus and extending into the right foramen ovale, and partially into the right foramen rotundum and right superior orbital fissure. There is associated enhancement along the right trigeminal nerve including cisternal segment as well as components in the Meckel's cave and cavernous sinus and the branches in the foramen ovale, foramen rotundum and superior orbital fissure. The component involving the cisternal segment of the right trigeminal nerve was not identified on the prior exam indicating interval progression. Differential considerations include infiltrating neoplasm and granulomatous disorder.2.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related. 3.Patchy lesions in the brainstem are likely vascular related.