 There is a focus of high-T2 and low-T1 signal without enhancement around the cerebral aqueduct at the level of the midbrain (series 501 image 12) with possible additional T2 hyperintensity involving the right pulvinar. No mass effect or abnormal enhancement. Remainder of the brain demonstrates no evidence of acute infarct, intracranial mass effect or abnormal parenchymal or meningeal enhancement.There is no abnormal enhancement or mass involving the bilateral cisternal segments of the trigeminal nerve, Meckel cave, or cavernous sinuses; please note however exam is not tailored for optimal evaluation of these cranial nerves. There is preserved fat signal in both pterygopalatine fossae. The ventricles and basal cisterns are normal in size and configuration without hydrocephalus. There is no midline shift or herniation. There is a small mucus retention cyst in the right maxillary sinus. The skull and extracranial soft tissues are unremarkable.
1. No acute infarct, mass effect, or pathologic intracranial enhancement. Particularly no abnormal enhancement or mass is seen involving the cisternal segment of the trigeminal nerve, Meckel cave, or cavernous sinuses. Please note exam is not tailored for optimal evaluation of cranial nerve V and additional imaging can be considered if there is continued suspicion for a structural lesion.2. Abnormal T2 hyperintensity surrounding the cerebral aqueduct at the level of the midbrain, right greater than left, with additional small T2 hyperintensity involving the right thalamus (coronal T2 19/32, axial T2 12-14/28) . No mass effect or abnormal enhancement. Differential is broad and includes prior insult from ischemia, demyelination, infection/inflammation, or prior toxic-metabolic injury (such as Wernicke's). MRI of the brain is otherwise unremarkable with no other lesions to suggest multiple prior infarcts or demyelinating disease.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.