Clinical question: Evaluate intracranial lesion seen on head CT. Signs and symptoms: As above. Pre- and post enhanced brain MRI:Examination demonstrates a right subfrontal paramedian well-demarcated mass with diffuse enhancement and surrounding vasogenic edema. Mass effect deep to represent a meningioma arising from the right anterior clinoid and right planum sphenoidale region. The mass and its surrounding vasogenic edema results in effacement of adjacent cortical sulci and trace dilatation of midline to the left. There is no evidence of ventriculomegaly. The mass appears to extend to the medial aspect of right middle cranial fossa anteriorly and likely traversing the right superior orbital fissure. There is also apparent involvement of right optic nerve canal and right supraclinoid internal carotid and partially into the right and anterior aspect of sella. The dictated MRI of ORBIT and more precisely assess the extent of the lesion. There is superior growth of tumor which invaginates into the right frontal lobe. The subfrontal and right middle cranial fossa component of tumor measures approximately 45 mm in craniocaudad axis and 36 mm in AP axis along the floor of the anterior cranial fossa.There are mild tiny foci of FLAIR hyperintensity involving the subcortical and periventricular white matter which considering patient's stated age of 76 most likely representing mild chronic small vessel ischemic strokes without evidence of hemorrhage. Unremarkable pre and post enhanced exam otherwise.
1.Right paraclinoid subfrontal meningioma with surrounding vasogenic edema and resultant trace deviation of midline to the left as detailed/measured above.2.There is extension of tumor into the right middle cranial fossa, suspected right orbital apex, right optic nerve canal, right supraclinoid carotid and right aspect of the sella which requires further evaluation with dedicated MRI of ORBIT and sella to precisely assess the extent of the tumor.3.Negative diffusion-weighted images and mild chronic nonhemorrhagic small vessel ischemic strokes.