Clinical question: Evaluate for cause of double vision, intraocular lens implant bilaterally. Signs and symptoms: Double vision for 12 days. Pre and post enhanced cervical MRI:Unremarkable diffusion-weighted series.Examination demonstrate scattered numerous foci of FLAIR and T2 hyperintensity in the subcortical and periventricular white matter of bilateral cerebral hemispheres and minimally in the basal ganglia and pons. Findings are nonspecific, nonhemorrhagic and demonstrate no abnormal enhancement. However considering patient's stated age of 83 this appearance is often result of microvascular ischemic changes.The signal intensity of the renal cortex and cerebellum remains within normal.There is mild generalized prominence of cortical sulci which are likely within normal for patient's stated age. The ventricular system remains within normal for age and with maintained midline.The signal voids of major intracranial arterial branches are all identified.Postcontrast images demonstrate no abnormal enhancement of brain parenchyma or the leptomeninges. However expected enhancement of a small developmental venous anomaly in the left median pons is detected.There is a focus of signal void abutting the inner table of the skull in the right frontal skull with subtle mass effect on the adjacent right frontal lobe however without detectable parenchymal signal change or abnormal enhancement. Finding is believed to represent hyperostosis of the inner table of the skull on the right and of no clinical significance.Pre- and post enhanced MRI of orbits:Images through the orbits demonstrate symmetrical bilateral lobes without detectable lenses. Signal intensity at the expected site of lenses consistent with lens implant is however detected. There is no abnormal enhancement of the globes. The retro-orbital fat remains within normal and without abnormal enhancement.Extraocular musculature are within normal size, morphology and signal intensity and without abnormal enhancement.Bilateral optic nerves demonstrate normal signal intensity and without abnormal enhancement.Bilateral lacrimal glands demonstrate normal signal intensity and without abnormal enhancement.Bilateral cavernous sinuses are within normal size and pattern of enhancement.The suprasellar visual complex demonstrate normal signal intensity and without abnormal enhancement.
1.Brain MRI demonstrate no acute intracranial process. Finding consistent with chronic nonhemorrhagic small vessel ischemic strokes in the subcortical and periventricular white matter and minimally in the basal ganglia and pons as detailed. No abnormal parenchymal or leptomeningeal enhancement. Tiny left paramedian pontine developmental venous anomaly however is noted on post enhanced series. Hyperostosis frontalis interna of right frontal bone.2.Unremarkable pre and post enhanced MRI of orbits. Please see above comments.