Type I neurofibromatosis. Evaluate change in brainstem tumor or optic glioma MRI Brain: There is no restricted diffusion to suggest acute infarction. There are unchanged ill-defined foci of T2 hyperintensity involving bilateral globus pallidi and thalami. There is no mass effect. A hypothalamic mass abuts the posterior aspect of the optic chiasm measuring 14 x 11 mm (series 601, image 13), unchanged in size, and without significant enhancement. There is no evidence of intracranial hemorrhage. The pituitary gland appears unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. There are retained secretions within the right mastoid air cells. There is also a lower medullary lesion, described in the MRI Cervical spine section.MRI Cervical Spine: There is a T2 hyperintense infiltrative lesion within the lower medulla, with interval reduction in size of the T2 hyperintense component now measuring 6 x 5 mm (series 601, image 4), previously 10 x 8 mm. This medullary lesion no longer demonstrates contrast enhancement (seen on MRI 4/20/2015). The medulla is expanded measuring 17mm, unchanged from prior. There are enhancing, T2 hyperintense lesions involving the left C4 and C5 nerve roots, which expand their respective neural foramina. The left C4-5 lesion also has an enhancing intradural component measuring 6 mm, that causes mass effect on the left lateral aspect of the spinal cord, probably unchanged. There is a small syrinx involving the central canal of the spinal cord in the upper thoracic region (series 1601, image 9), present on prior and probably unchanged given limitations in technique.There is straightening of the cervical spine, which may be due to patient positioning. Alignment is otherwise normal. Vertebral bodies are preserved in height. There is no suspicious bone marrow signal. MRI Orbits: There is a 3-mm well-circumscribed (series 3401, image 7), minimally enhancing lesion abutting the inferior aspect of the left optic nerve, probably unchanged in size, but with reduced enhancement when compared to the MRI of 4/28/2015. Orbits and globes are otherwise unremarkable. The optic chiasm is normal. Optic tracts appear unremarkable.
1. No new lesions are identified.2. Infiltrative, expansive medullary mass extending to the cervicomedullary junction, with grossly unchanged brainstem expansion, but decreased extent of T2 hyperintensity and resolution of previously seen enhancement. 3. Probably unchanged T2 hyperintense lesions involving left C3-4 and C4-5 neural foramina, with mass effect on the left lateral spinal cord at C4-5.4. Unchanged lesions involving the hypothalamus, inferior aspect of the left optic nerve, basal ganglia and thalamus.5. Probably unchanged prominence of the central canal of the spinal cord involving the upper thoracic central spinal cord.