55 years, Female, imbalance, left-sided tinnitus and aural pressure. Asymmetric sensorineural hearing loss. There is moderate degree of global supratentorial and infratentorial parenchymal volume loss which is advanced for patient's age, but not appreciably changed since 7/3/2012. Ventriculomegaly is also not significantly changed and appears somewhat disproportional to the degree of volume loss. Cerebral aqueduct appears grossly patent. There are multiple foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific, and also not significantly changed. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. No evidence of mass effect, midline shift or herniation. Mild opacification of the right-sided mastoid air cells. Partially empty sella is again seen which is nonspecific and may be normal variant or associated with intracranial hypertension in the appropriate clinical setting.High-resolution noncontrast images of the internal auditory canals demonstrate an approximately 7 x 8 x 6 mm nodule involving the left internal auditory canal. This lesion does not appear to extend into the cochlea. Bilateral cerebellopontine angles and remainder of the visualized inner ears structures are grossly unremarkable within the limitations of noncontrast study.
1. 8 x 7 x 6 mm lesion involving the left internal auditory canal is not well evaluated without contrast but suspected to represent a vestibular schwannoma.2. Remainder of the brain parenchyma demonstrates global parenchymal volume loss supra and infratentorially which is prominent for patient's age, but not significantly changed since 7/3/2012. There are also multiple foci of T2/FLAIR hyperintensity in the bilateral subcortical and periventricular white matter which are nonspecific but may represent mild chronic small vessel ischemic disease. Sequela of prior inflammation or less likely demyelination are other possibilities.3. Ventriculomegaly also remains unchanged since 2012. Suggest correlation for clinical signs of communicating hydrocephalus/NPH, which incidentally has been associated with a vestibular schwannomas.