Dizziness and giddiness [R42], Reason for Study: ^Reason: stroke History: stroke 59 years Female (DOB:11/14/1957)Reason: stroke History: strokePROVIDER/ATTENDING NAME: JAMES AHN DAVID G. BEISER Brain MRIThere is well enhancing mass located at the left jugular foramen with irregular margin and associated with adjacent bony erosion. The mass is measured about (32.5 mm x 34.6 mm x 22 mm) with the branching patterned signal void within the lesion indicating hypervascular nature. There is also separate about 8 mm sized round enhancing nodular lesion of the left with the left middle cerebellar peduncle which shows nearly circular thin peripheral T2 low signal intensity. This lesion is associated with the surrounding brain edema.Constellation of above findings indicate hypervascular mass such as glomus jugulare located on the left jugular foramen. Differential diagnosis of the separated enhancing lesion on the left middle cerebellar peduncle include thrombosed vascular structure including arterial aneurysm and acute hemorrhagic lesion.There is evidence of previous left mastoidectomy as well as suboccipital craniectomy with scattered susceptibility lesions surrounding the enhancing mass indicating postoperative status of the enhancing mass lesion.No other abnormal enhancing lesion is seen.There is no evidence of acute ischemic lesion.Scattered T2/FLAIR high signal intensity lesions indicating nonspecific small vessel ischemic disease.The ventricles, sulci and cisterns are unremarkable. The paranasal sinuses and right mastoid air cells are clear.Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate normal ICAs, MCAs and ACAs. Vertebrobasilar system appears to be normal.There are multiple branching patterned in flow enhancement is seen on the left skull base indicating hypervascularity of the left the jugular foramen lesion.Neck MRA3D MRA neck post-gadolinium images with maximum intensity projections of the cervical vasculature demonstrate normal flow enhancement in a normal aortic arch origin of the right brachiocephalic, left common carotid, and left subclavian arteries. The vertebral artery origins are normal. There is normal flow enhancement through the bilateral common carotid, carotid bifurcations, internal/external carotid, and vertebral arteries. Left the subclavian artery midportion shows focal signal loss which is likely indicate artifactual.Brain MRV3D MRV brain post-gadolinium with maximum intensity projections of the superficial/deep intracranial venous drainage demonstrate hypoplastic left transverse sinus with nonvisualization of left sigmoid sinus indicating possible occlusion due to enhancing jugular foramen mass. Otherwise, normal flow enhancement in the superior sagittal sinus, right transverse sinuses, right sigmoid sinuses, internal cerebral veins, vein of Galen and straight sinus.
1. Hypervascular left jugular foramen area lesion with the significant signal void within the mass associated with evidence of left mastoidectomy indicate postoperative status of left glomus jugulare or other hypervascular mass.2. Separated enhancing lesion within the left middle cerebellar peduncle likely represent thrombosed vascular structure such as thrombosed aneurysm or vein, or possible focal hemorrhage. CTA can be considered for further imaging evaluation.2. Non specific small vessel ischemic disease.3. Normal brain MRA with evidence of hypervascular tumor on the left jugular foramen.4. Normal neck MRA with again visualized hypervascular mass on the left jugular foramen area.5. Occlusion of the left sigmoid sinus likely due to the left jugular foramen area mass, otherwise unremarkable brain MRV.