Diagnosis: Benign neoplasm of cerebral meninges. Other symptoms involving nervous and musculoskeletal systems(781.99)Clinical question: evaluate right petrous apex meningioma, and for episodes of transient speech difficulty of unclear etiology MRI of the brainThere is a 11x8 mm axial dimension extra-axial mass at the right cerebellopontine angle cistern just anterior to the porus acusticus which is adjacent to the posteromedial aspect of the right petrous apex and has a dural tail extending over the superior aspect of the right petrous apex. There is an associated dural tail which extends into the right internal auditory canal. The mass abuts but does not distort the adjacent pons. The right trigeminal nerve runs over the medial and superior aspect of the mass. The abducens nerve is expected to run between the mass and the basilar artery. On 8/1/13 it had similar dimensions.No diffusion weighted abnormalities are appreciated.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.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified and is small to medium size. The right posterior communicating artery is small but intact. The left posterior communicating artery is small to medium size but intact. The LVA is larger than the RVA.MRA neck:There is opacification of the aortic arch, great vessels from the aortic arch and carotid arteries and vertebral arteries. There is no stenosis identified of the great vessels from the aortic arch. On the basis of NASCET criteria there is no significant stenosis at the carotid bifurcations. There is no significant stenosis along the course of the vertebral arteries.
1.There is a right cerebellopontine angle cistern and petrous apex mass which is suspicious for a meningioma. There is an associated "dural tail" which extends into the right internal auditory canal. It is stable compared to the prior exam from 8/1/13.2.No evidence for acute ischemic cerebral infarction3.No evidence for intracranial cerebrovascular occlusive disease.4.No evidence for extracranial cerebrovascular occlusive disease.