 This exam is mildly degraded by motion artifact.BRAIN: There are scattered patchy foci of T2 hyperintensity within the periatrial white matter, thalami, cerebral peduncles, midbrain, pons, medulla, middle cerebral peduncles, and cerebellar white matter. There is more prominent focal T2 hyperintensity within the posteromedial left thalamus with slight mass-effect. In addition there is mild expansion and T2 hyperintensity within the mesial left temporal lobe. Of note, the above lesions do not enhance.There is abnormal thickening, T2 hyperintensity, and pathologic enhancement within the bilateral optic nerves involving the intraorbital, intracanalicular, and right intracranial segments. The intraorbital segments measure up to 6 mm on the left and 5 mm on the right. There is no evidence of acute infarct. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are unremarkable. CERVICAL SPINE: At C1-C2 there is mild ill-defined T2 hyperintensity and slight cord expansion without definite enhancement on this motion degraded exam. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. There is mild prominence of the exiting nerve roots of the lower cervical spine bilaterally. There are slightly prominent lymph nodes vs. neurofibromas within the bilateral jugular chains and lateral retropharyngeal spaces.
1.Scattered patchy foci of T2 hyperintensity within the thalami and posterior fossa are compatible with lesions related to NF1. Close attention on follow up exams is suggested for two regions of more prominent T2 hyperintensity and slight mass effect within the left thalamus and medial left temporal lobe which may represent low grade gliomas. 2.Bilateral optic nerve gliomas extending to but not involving the optic chiasm. 3.Upper cervical spinal cord lesion, non specific but given the context, suspicious for low grade glioma. 4.Borderline lymph nodes vs. small neurofibromas in the retropharyngeal spaces and bilateral jugular chains. 5.Questionable small neurofibromas involving the exiting nerve roots at the lower cervical levels bilaterally. 