Clinical question: Assess brain lesions. Signs and symptoms: seizure. Non-enhanced CT brain:Examination demonstrate a well demarcated low attenuation lesion in the inferior right frontal lobe. There is effacement of adjacent cortical sulci and minimal indentation of right frontal horn. There is no interval change since prior examination of 5 -- 11 -- 2010.Additional small foci of low attenuation adjacent to the trigone of right lateral ventricle is also again identified and read no interval change. There are two additional apparent cortical based low attenuation in the left mid temporal lobes with no evidence of interval change. Subcortical low-attenuation in the right frontal lobe along to its interhemispheric aspect extends inferiorly to the level of previously described right frontal lobe lesion.These findings on MRI examination of brain on the same date do not have the appearance of stroke.There is bony thickening and new bone formation along the floor of anterior cranial fossa with possibly some internal lytic changes. This finding may represent fibrous dysplasia. This finding is immediately at the level of large right frontal lobe lesion and I can't be certain whether this finding is related to intracranial findings.CTA of intracranial circulation:Carotid system.Right internal carotid. Normal interval carotid artery across the cavernous sinus and in its supraclinoid portion. There is normal appearing right anterior and middle cerebral arteries and their branches. Review of coronal, sagittal and axial 2-D MIP images demonstrate no definitive evidence of any detectable abnormality in the distal branches of anterior and middle cerebral arteries that are not well visualized on the 3-D reformatted images.Left carotid.The left internal carotid artery across the cavernous sinus and its supraclinoid portion remains within normal. There is also normal visualization of the left anterior annular cerebral arteries and their branches. To evaluate the distal branches of left anterior and middle cerebral arteries which are not visualized on 3-D reformatted images the 2-D MIP images in coronal, sagittal and axial sequences were reviewed. These 2-D images fail to demonstrate any detectable abnormality of distal branches.Vertebral basilar system.There is normal visualization of bilateral vertebral arteries and their intracranial component. Basilar artery and all of its branches are well visualized and unremarkable.65 cc of Omnipaque 350 was administered for above study.
1.Stable unenhanced CT examination of brain since prior exam. Multiple intracranial findings are highly suspect for masses and unlikely to represent strokes.2.Expansile bony lesion of right frontal bone along the floor of the right anterior cranial fossa may represent fibrous dysplasia, however the large right frontal lobe lesion that abuts the inner table of the skull in the right frontal lobe may represent a combined osseous and intracranial pathology like a neoplasm. Patient had a nonenhanced MRI of brain however an enhanced MRI is highly recommended to further evaluate multiple unusual intracranial lesions. Please reviewed report of an enhanced MRI of brain.3.Negative CTA of intracranial vasculature.4.CTA is not in the appropriate test for detection of intracranial enhancement. 