60-year-old male with right arm intention tremor and question raised in outside MRI 3/2016 of low grade neoplasm in the pons. There has been evolution of the prior infarct involving the right thalamus extending into the midbrain on outside brain MRI from 10/17/2016. There is T2/Flair hyperintense signal involving the right midbrain cerebral peduncle with associated volume loss indicating chronic infarct and/or associated Wallerian degeneration. There is additional T2/FLAIR signal abnormality involving the right greater than left pons which is not significantly changed compared to the prior exams from 3/3/2016. There is no discrete evidence of pontine expansion or enhancement. Separately more dorsally in the pons is additional T2/FLAIR signal, again indicating an appearance most consistent with small vessel ischemic disease. There is additional scattered periventricular and subcortical white matter T2/FLAIR hyperintensity, which is nonspecific but likely related to underlying chronic small vessel ischemic disease. Chronic lacunar infarcts are evident in the right frontoparietal corona radiata similar to prior.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 scalp soft tissues are grossly unremarkable.
1.Compared to 10/17/2015, there has been evolution of the previously seen infarct involving the right thalamus extending into the right midbrain.2.T2/FLAIR signal abnormality involving the bilateral pons is not significantly changed since 3/3/2016 and favored to represent sequela of chronic small vessel ischemic disease or perhaps prior osmotic demyelination or other inflammation. Pontine glioma, as questioned, seems much less likely given absence of expansion or enhancement and evidence of prior infarcts. Additional follow-up can be considered as clinically warranted.3.Additional evidence of mild chronic small vessel ischemic disease including lacunar infarcts along the right frontoparietal corona radiata.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.