Relapsed multiple myeloma with new left mental numbness. Evaluate for cranial nerve involvement or lytic bone lesions. There is no evidence of marrow replacement corresponding to the lytic lesion of the left mandible as seen on prior maxillofacial CT. There is no evidence of acute intracranial hemorrhage, mass, or acute infarct. There are scattered punctate foci of abnormal T2 hyperintensity within the periventricular and subcortical white matter, consistent with mild chronic small vessel ischemic changes. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. There is evidence of right uncinectomy. There is marked mucosal thickening of the left maxillary sinus. There is mild mucosal thickening of the right maxillary and bilateral sphenoid sinuses. There is diffuse mucosal thickening of the bilateral ethmoid sinuses.
1. No evidence of marrow replacement corresponding to the area of the left mandibular lytic lesion as seen on prior maxillofacial CT, to suggest that the lytic lesion on CT would represent a myelomatous lesion. Please note that only part of the mandible was included on this exam.2. No evidence of intracranial hemorrhage, mass, or acute infarct.3. Diffuse paranasal sinus opacification. 