Reason: r/o seizure focus and stroke History: facial twitching, weakness The CSF spaces are appropriate for the patient's stated age with no midline shift. There is redemonstration of an extra-axial mass located the level of the foramen magnum and premedullary cistern, anterior to the medulla and cervicomedullary junction an eccentric towards the left which measures 11 x 32 mm sagittal dimensions on the current exam and previously measured 11 x 32 mm sagittal dimensions. It is associated with mild displacement of the cervicomedullary junction posteriorly. It abuts, partially surrounds and displaces the left vertebral artery.There are T2 and flair signal hyperintensities present in the cerebellar hemispheres, pons and midbrain as well as the thalami and basal ganglia bilaterally. These are associated with a similar distribution but lesser in number of signal hypointensities on susceptibility imaging.There is a mild degree of periventricular and subcortical confluent hyperintense white matter lesions present identified on the FLAIR and T2 images.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate minor mucosal thickening in the right maxillary sinus. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.
1.Since the prior examination an extra-axial mass at the level of the foramen magnum has not changed substantially in dimensions. This mass partially encases the left vertebral artery.2.Microhemorrhages in the brainstem, thalami and basal ganglia are in a distribution suggestive of hypertension.3.Periventricular and subcortical white matter changes of a moderate degree are nonspecific. At this age they are most likely vascular related. 4.Lesions are also present in the basal ganglia, thalami, brainstem and cerebellar hemispheres. These are suspected to be related to prior vascular insults.