Female, 15 years old, with history of NF1 and worsening headaches and neck pain. Brain:Multiple scattered areas of cortical and subcortical T2 hyperintensity are demonstrated involving the high left frontal lobe, both parietal lobes and questionably along the right medial temporal lobe. All of these lesions are new when compared to the prior MRI examination from 2012. The largest lesion, within the right parietal lobe, also demonstrates several small foci of susceptibility suggesting minimal blood product. This lesion also seems to exert a slight local mass effect.A punctate nonspecific focus of T2 hyperintensity within the right centrum semiovale is unchanged. Small foci of T2 hyperintensity seen within the thalami on the prior examination are not distinctly appreciated on today's study. A focus of nonspecific T2 hyperintensity within the left restiform body is new, as is a focus slightly lower at the right posterior cervico-medullary junction.No evidence of restricted diffusion is seen. No significant generalized mass effect is detected. No large intracranial hemorrhage or abnormal extra axial fluid collection is seen. The ventricles are normal in size and morphology.Although this is not a dedicated examination of the optic pathways, the orbital structures appear to be within normal limits and no optic pathway masses are suspected.C-spine:Apart from the cervico-medullary signal abnormality discussed above, the cervical spinal cord shows normal signal intensity and morphology. No intraspinal masses are appreciated.The spinal alignment is anatomic. Vertebral body height and morphology are normal. No concerning marrow signal abnormality is detected.No evidence of significant spinal canal or neuroforaminal stenosis is seen.Soft tissue neck:The soft tissue structures of the neck are within normal limits. No pathologic adenopathy is detected in the cervical region. There may be some mildly prominent lymph nodes in the upper mediastinum but these are nonspecific. No convincing evidence of any large neurofibroma or other mass lesion is seen.
Multiple areas of new pathologic T2 signal are seen within the cerebrum and brainstem. Some of these could reflect FASI of neurofibromatosis, particularly the brainstem lesions and perhaps also the lesion along the right medial temporal lobe, as these are fairly characteristic locations.Many of the lesions, however, show morphology and distribution which are atypical for FASI. In particular, the dominant lesion in the right parietal lobe seems to exert some degree of local mass effect and is associated with small quantities of blood product, which are not typical features of FASI. The imaging features of these lesions are, however, fairly characteristic for a PRES-like vascular phenomenon, and based on review of the medical record, the patient does appear to have risk factors for this condition.Assessment of the cervical spine and soft tissues of the neck is within normal limits. No specific lesions are seen which would account for the patient's symptoms.