Evaluate optic glioma, any evidence of hypothalamic tumor: girl with NF1 and premature adrenarche. Orbits: There is diffuse enlargement of the bilateral intraorbital and canalicular segments of the optic nerves, measuring up to 5 mm in thickness on the right and 7 mm in thickness on the left. However, there is no associated abnormal enhancement. The other intraorbital contents are unremarkable bilaterally.Brain: There is mild enlargement of the post-chiasmatic segments of the bilateral optic nerves in continuity with the more anterior involvement. However, the hypothalamus appears to be intact. There is an ovoid T2 hyperintense lesion in the right body of the corpus callosum that measures up to 10 mm. There are also unchanged patchy areas of T2 hyperintensity in the bilateral cerebellar hemispheres, as well as in the brainstem, and perhaps in the thalami. There is no evidence of associated abnormal enhancement, however. The pituitary gland is unremarkable. There is an unchanged cavum velum interpositum cyst. The ventricles are otherwise normal in size and configuration. There is no midline shift or herniation. The left internal carotid artery flow void is diffusely diminutive. The skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. There are retained secretions in the left petrous apex air cells.
1. Bilateral optic gliomas without evidence of hypothalamic involvement.2. Multiple unchanged supratentorial and infratentorial lesions also likely represent stigmata of neurofibromatosis type 1.3. Diffuse stenosis of the left internal carotid artery is also likely associated with neurofibromatosis type 1. Dedicated vascular imaging of the head and neck may be useful for further evaluation.