22 years Male (DOB:9/1/1993)Reason: evaluate for etiology of decreased vision, headache History: lymphoma, sigmoid sinus thrombosisPROVIDER/ATTENDING NAME: GREG TOMCZYK CHADI NABHAN MRI brain:There is redemonstration of a marrow replacing lesion which involves the clivus and right petrous bone surrounding the carotid canal and extending to the right jugular bulb with a soft tissue component which extends towards the right carotid space and jugular vein and a small component of the right lateral aspect of the right prevertebral space at the level of the occipital condyle.. This has been present on the prior exam and does not appear to have significantly changed since 5/13/2016 exam.There is redemonstration of enhancement along the sphenoid wings and mandibular heads bilaterally. This does not appear to have changed substantially since the prior exam. There is additional patchy involvement of the masticator spaces which relatively stable.There is enhancement of the trigeminal nerves present extending to the root entry zones. This has progressed since the previous exam. There is some contrast enhancement present along the cranial nerves VII and VIII. There is subtle enhancement along the third cranial nerves bilaterally.Small enhancing focus is present at the right hypoglossal canal and extending into the right cerebellar medullary angle cistern. It appears to abut the right cerebellar hemisphere at that location. This appears to have slightly progressed compared to the prior exam. It currently measures approximately 11 x 6 mm in axial dimensions and previously measured 3 x 11 mm axial dimensions. There are some subtle enhancement along the surface of the medulla and cerebellum at the left cerebellar medullary angle cistern.A ventriculostomy tube courses of the right frontal lobe into the right lateral ventricle with tip in the region of foramen of Monro. The lateral ventricles are stable in size.No abnormal enhancing mass lesions are appreciated within the brain parenchyma. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.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 are clear. The visualized portions of the mastoid air cells demonstrate opacification of the right mastoid air cells. The visualized portions of the orbits are intact.MRI orbits:The eyeballs are intact. No intraconal or extraconal space mass is identified. The extraocular muscles are intact. The lacrimal glands are symmetric and within normal limits in size and configuration. There is no optic nerve enhancement appreciated. The suprasellar cistern is intact .Findings suggest some enhancement along the dural sleeves of the optic nerves bilaterally. This appears to be new since the prior exam.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified. The posterior communicating arteries are not readily identified. The vertebral arteries are similar in size.MRV brain:There is redemonstration of intraluminal filling defect within the right jugular bulb and right sigmoid sinus.The rest of the dural venous sinuses are patent. Straight sinus, internal cerebral veins and basal veins are identified and appear patent.
1.Since the prior exam there appears to be some dural involvement involving the dural sleeves of the optic nerves bilaterally. 2.Since the prior examination patient developed new cranial nerve enhancement involving the fifth cranial nerves bilaterally but also the cranial nerves VII and VIII and possibly the third cranial nerves. Suggesting leptomeningeal or direct cranial nerve involvement/reaction.3.There is redemonstration of a skull based tumor involving clivus and right petrous bone with associated extension into the right carotid space and right prevertebral space. This appears to be relatively stable in extent when compared to the previous exam. Some extension into the right cerebellar medullary angle cistern appears to be slightly progressed compared to the prior exam. There is additional marrow involvement which includes the sphenoid wings and sphenoid bone and mandibular heads as well as portions of the masticator space which are stable.4.There is a intraluminal filling defect within the visualized portions of the proximal jugular vein and distal sigmoid sinus which could represent thrombus and/or tumor.