53 years, Male, pleural mesothelioma with lung metastases. Presents with nasal field defect in the left eye. There is marked mucosal thickening within the left nasal cavity, with no underlying lesion identified. There is no restricted diffusion to suggest acute ischemia. There are multiple areas of periventricular and subcortical T2 hyperintensity. There is also T2 hyperintensity within the globus pallidi and pons. The globus pallidi are otherwise unremarkable. There is no intracranial hemorrhage. The ventricles are within normal limits in size and configuration. There is no abnormal meningeal enhancement. Major flow-voids are preserved. Sella and orbits are grossly within normal limits. Bone marrow signal and extracranial soft tissues are within normal limits. Incidental note is made of asymmetric mucosal swelling within the left nasal cavity.
Nonspecific T2 hyperintense lesions within the periventricular and subcortical white matter, and pons most likely secondary to chronic microvascular ischemic disease. However there are additional areas of T2 hyperintensity within the globus pallidi bilaterally, which are atypical, and may be due to a combination of chronic microvascular ischemic disease and/or remote toxin exposure such as carbon monoxide.