Clinical question: Evaluate interval enlargement of possible frontal meningioma. Signs and symptoms: CTH with enlarged possible meningioma. Nonenhanced brain MRI:No acute intracranial process and negative diffusion weighted series.Examination demonstrates a dural based extra-axial mass in the anterior left middle cranial fossa along the inner table of the great wording of sphenoid. It measures at 32 x 17 mm in transaxial dimensions (axial T2 series 6 image 19). There is resultant mass effect and posterior displacement of left temporal tip however without detectable FLAIR or T2 signal abnormality to suggest vasogenic edema. The location and signal intensity of the finding is suggestive of a meningioma. No contrast was given.Additionally examination demonstrates scattered periventricular and subcortical as well as bilateral basal ganglia and minimally pontine foci of FLAIR hyperintensity which considering patient's stated age of 77 likely representing chronic nonhemorrhagic small vessel ischemic strokes of moderate degree.The signal intensity of cerebral cortex is within normal.Cortical sulci and ventricular system as well as the CSF spaces are otherwise unremarkable. The signal void of major intracranial arterial branches are identified.Signal intensity of intracranial venous sinuses are unremarkable.Mild mucosal thickening of all visualized paranasal sinuses are noted. Bilateral mastoid air cells and middle ear cavities demonstrate normal pneumatization signal patterns.
1.Dural based extra-axial mass in the left anterior middle cranial fossa presumed a meningioma is again noted. Subtle mass effect on the left anterior temporal tip without vasogenic edema or midline shift.2.Negative diffusion weighted images and findings suggestive of mild to moderate chronic nonhemorrhagic small vessel ischemic strokes are noted.