12-year-old female with blurry vision and concern for infectious extension from meningitis and mastoiditis. MRI Brain:Redemonstrated is prominent abnormal thickening and enhancement involving the bilateral cavernous sinuses, pituitary region, dura along the inferomedial frontotemporal lobes, and cisternal segments of the trigeminal nerves. The right VII/VIII nerve complex is also enhancing. Diffuse sulcal enhancement/vascularity has progressed. However, there are no areas of abnormal brain parenchymal enhancement, restricted diffusion, edema, discrete or rim-enhancing fluid collections or other evidence of abscess formation. The ventricles remain normal in size and morphology.There is persistent extensive fluid through the bilateral mastoid air cells, middle ear cavities and petrous apices with associated enhancement. The material filling the mastoid air cells may be mildly diffusion restricted. There is also persistent paranasal sinus thickening and enhancement with fluid, particularly within the sphenoid sinuses. The left external auditory canals remains completely opacified with scattered patchy enhancement. The right external auditory canal is now at least partially patent on today's exam. MRI Orbits:Thin section MRI through the orbits demonstrates abnormal enhancement involving the optic nerve sheaths bilaterally. The extraocular muscles, orbital soft tissues and globes appear unremarkable. As noted above and on the prior examination, the cavernous sinuses are expanded and abnormally enhancing. Patchy diffusion restricting material is seen within the petrous apices and to a lesser extent the cavernous sinuses. The pituitary gland is again noted to be large.MRV Brain:There is mild normal variant hypoplasia of the left transverse sinus. The superior sagittal sinus, inferior sagittal sinus, transverse sinuses, sigmoid sinuses, straight sinus, vein of Galen, internal cerebral veins, and visualized cortical veins are patent. There is no evidence of venous thrombosis.
1.Findings are redemonstrated compatible with extensive bilateral otomastoiditis and sinusitis. Associated dural thickening and enhancement as well as sulcal enhancement are seen compatible with meningitis. No discrete or rim-enhancing intracranial collections are demonstrated to suggest abscess formation.2.As on the prior examination, the cavernous sinuses are expanded and abnormally enhancing likely indicating infectious involvement. This alone could produce visual symptoms due to cranial nerve irritation. However, note is also made of abnormal enhancement along the intraorbital optic nerve sheaths which may reflect elevated intracranial/orbital pressures, reactive inflammation or spread of infection.3.The intracranial MRV is within normal limits.4.As on the prior examination, the pituitary is noted to be enlarged. This may reflect infectious involvement of the sella, though it could also be physiologic in a patient of this age.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.