Female, 18 years old, with neurofibromatosis type I and moyamoya syndrome, known brainstem tumor and frontal white matter encephalomalacia. Presenting with left pupil dilation and exotropia, dysarthria. Evaluate for new infarct or tumor. A heterogeneously enhancing tumor is redemonstrated within the right aspect of the midbrain measuring 22 x 19 x 19 mm, not significantly changed from the prior examination. No new enhancing or masslike lesions are observed.Encephalomalacia is again seen within the deep left frontal white matter, and involving the right temporo-occipital cortical and subcortical tissues, without significant interval change. No new parenchymal lesions are observed. No evidence of acute intracranial hemorrhage or any abnormal extra-axial fluid collection is seen. The ventricles are normal in size and morphology. Absence of the left sigmoid and transverse sinus flow void is noted, but this finding was present on multiple prior examinations and may simply be artifactual.A right basal ganglia developmental venous anomaly is suspected. The terminal ICA and MCA flow voids are not well seen compatible with the history of moyamoya disease. Postoperative findings compatible with bilateral pial synangiosis are redemonstrated.Findings related to cleft palate are partially visualized.
1.No change in the size of the midbrain tumor.2.No change in left frontal and right temporo-occipital encephalomalacia.3.No acute ischemia or other acute intracranial abnormality.