Left sided facial pain: evaluate for lesion along the trigeminal nerve. There is no evidence of acute infarct. There is a punctate focus of susceptibility effect in the left midbrain. The brain parenchyma otherwise appears unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is a left maxillary sinus retention cyst.
A punctate left midbrain focus of susceptibility effect may represent a chronic microhemorrhage or cavernous malformation, but no evidence of gross lesions along the imaged portions of the trigeminal nerves. Dedicated trigeminal nerve protocol MRI may be useful for further assessment.