Facial numbness, dizziness, hearing loss: chronic right sided weakness, abnormal VNG testing with left peripheral nystagmus, and right hearing loss. Brain MRI: There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are mild scattered cerebral white matter T2 hyperintense lesions. A vein courses along the superior aspect of the left trigeminal nerve. Otherwise, there is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. However, there is a partially-empty sella. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is mild mucosal thickening in the right maxillary sinus. Brain MRA: There is no evidence of significant steno-occlusive lesions or saccular aneurysms.Internal Auditory Canals MRI: The bilateral cranial nerve 7 and 8 complexes are intact. There is no evidence of mass lesions. The inner ear structures, including the cochlea, vestibule, endolymphatic duct and sac, and semicircular canals, appear unremarkable. There is a mild effusion within the right mastoid air cells. The left mastoid air cells are unremarkable.
1. Mild scattered cerebral white matter T2 hyperintense lesions and nonspecific, but may be related to chronic small vessel ischemic disease. Otherwise, no evidence of intracranial hemorrhage, mass, or acute infarct. 2. No evidence of significant steno-occlusive lesions 3. No evidence of retrocochlear or inner ear lesions.4. Mild right mastoid air cell effusion.5. A partially-empty sella is nonspecific, but may represent a manifestation of pseudotumor cerebri, especially in the setting of obesity. 6. A vein courses along the superior aspect of the left trigeminal nerve, which can be an anatomic variant. 