Worsening left eye ptosis and possible fungal infection. Orbits: There is focal high T2 signal and enhancement in the right medial rectus muscle, left superior rectus-levator complex, There are also focal enhancing lesions in the right temporal fossa, left masticator space, along the levator labii superioris in the right medial check, and possibly the right frontal scalp, along the frontalis muscle. Some of the lesions display a punctate area of central non-enhancement.Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and mastoid air cells are grossly unremarkable.
1. Multifocal lesions involving the bilateral extraocular muscles, as well as several other maxillofacial muscles. These lesions may represent an infectious process, such a disseminated fungal disease, possibly with microabscesses, or perhaps a manifestation of leukemia.2. Paranasal sinus inflammatory changes with secretions that could represent fungal disease. 3. No evidence of acute intracranial abscess or tumor.