Clinical question: History of meningioma, reassess. Signs and symptoms: Memory loss. Pre and post enhanced brain MRI:No diffusion-weighted abnormality.Examination demonstrates a previously known meningioma in the left paraclinoid region measuring at 18 x 23 mm in transaxial dimensions and with uniform enhancement. It demonstrates no convincing evidence of interval increased size or its subtle mass effect on the adjacent left anterior temporal lobe. There is no evidence of parenchymal edema which is a similar observation is prior study. The patient is not in contact with the major intracranial vasculature and there is no evidence of involvement of the cavernous sinus.An additional pleural-based left posterior parietal-occipital paramedian meningioma with uniform enhancement without significant change since prior exam. Finding measures approximately at 19 x 9 mm in transaxial dimensions which is larger than prior study measurement of 13 x 8 mm. This finding results in subtle buckling of the adjacent parenchyma and demonstrate minimal invasion into the adjacent superior sagittal sinus which is more conspicuous on current study compared to prior exam and is best appreciated on axial T2 series 1401 image 23.There are few small foci of FLAIR hyperintensity in the subcortical white matter of bilateral cerebral hemispheres mostly in the posterior parietal and suspected of minimal chronic small vessel ischemic strokes without change since prior exam.Slight prominence of cortical sulci and supratentorial ventricles similar to prior exam and unremarkable exam otherwise.
1.Slight interval increased size of left posterior parietal-occipital paramedian meningioma and with more conspicuous subtle invasion of the adjacent superior sagittal sinus as detailed.2.Stable left paraclinoid meningioma as detailed.3.No diffusion-weighted abnormalities. Stable findings suggestive of mild chronic small vessel ischemic strokes.