60 years Female (DOB:8/19/1955)Reason: evaluate for progression of retroclival idiopathic pachymeningitis seen on previous MRI History: headache, photophobia, neck painPROVIDER/ATTENDING NAME: AIMEE A. MAYUGA SERVICES ANCILLARY There is an extra-axial mass present adjacent to the clivus extending from the level of the foramen magnum to the inferior aspect of the posterior clinoid process measuring 51 x 11 mm axial dimensions. Superiorly it is eccentric towards the right side. On the prior exam it measured 1 x 11 mm sagittal dimensions as well.The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.
1.A posterior fossa extra-axial mass adjacent to the clivus isn't stable compared to prior exam. Pathologic description on 8/26/2015 suggests that it could represent a granulomatous process including idiopathic pachymeningitis which would be a diagnosis of exclusion. The MR findings would support this.2.Periventricular and subcortical white matter lesions of a mild degree are nonspecific. At this age they are most likely vascular related. 