88 years, Female, diplopia, assess for leptomeningeal disease. Brain: No restricted diffusion to suggest acute ischemia. No acute intracranial hemorrhage. No intracranial mass or mass-effect. The ventricles are within normal limits in size. Similar to prior, there are multiple foci of T2/FLAIR hyperintensity in the bilateral subcortical and periventricular white matter as well as in the pons, which are nonspecific, but compatible with moderate chronic small vessel ischemic changes. Global parenchymal volume loss is seen commensurate with patient's advanced age. There is again a question of small subdural hygromas in the posterior fossa but unchanged since 9/24/2013 and without mass effect. Unchanged focus of susceptibility in the left frontal lobe compatible with chronic microhemorrhage or calcification. No abnormal parenchymal or meningeal enhancement. Major flow-voids are preserved. Again seen is partially empty sella which is common in this age group. Bilateral lens implants again seen. Mild bilateral mastoid air cell opacification. Calvarium and extracranial soft tissues are otherwise grossly unremarkable.Orbits: There are no masses within the orbits or abnormal enhancement. Bilateral optic nerves demonstrate normal signal. Bilateral globes are intact. Bilateral lens implants are seen. Extraocular muscles are unremarkable. Minimal linear enhancement along the posterior aspect of the optic nerve sheaths is favored to be vascular in etiology and of doubtful significance. No suspicious enhancement within the orbits is definitively appreciated.
1. No evidence of acute ischemia. Moderate chronic small vessel ischemic disease, similar to prior study from 9/24/2013.2. No intracranial or intraorbital mass or abnormal parenchymal or leptomeningeal enhancement to suggest metastatic disease. If there is high suspicion for a leptomeningeal process, consider CSF analysis.