 There is an overall decrease in brain volume and white matter, with resultant prominence of extra-axial CSF. The corpus callosum directly interfaces with this overlying cerebrospinal fluid, which also indicates a paucity of gray matter. There is fluid in the nasal cavity with bilateral choanal narrowing, left greater than right. Anteriorly, the falx is dysplastic or partially absent. The internal auditory canals are narrowed. Dysmorphic external ears are suggested but not well delineated. Additional temporal bone abnormalities discussed on the prior study are also poorly delineated on today's MRI.No extra-axial fluid collection, hydrocephalus, or pathologic midline shift. Normal myelination pattern is observed for age. There are no focal lesions or areas of abnormal signal within the brain parenchyma. There is no acute intracranial hemorrhage. No evidence of acute ischemia on diffusion-weighted imaging. The corpus callosum and other midline structures are present. There is no cerebellar tonsillar herniation. Flow voids indicate patency of the major intracranial vessels.
1.No acute intracranial abnormality or focal lesion to account for the patient's symptoms. Global parenchymal volume loss including decreased white matter volume.2.Bilateral choanal atresia with dysmorphic ears and other abnormalities as described above. While not fully characterized on today's study, this constellation of findings is compatible with the patient's underlying history of Treacher-Collins syndrome.