14-year-old male with neurofibromatosis and new hearing loss, evaluate for vestibular schwannomas. Redemonstrated is an enhancing extra-axial mass within the right internal auditory canal extending into the adjacent cerebellar pontine angle measuring 12 x 9 mm in axial dimension (previously 11 x 7 mm). A similar-appearing, yet smaller, lesion is present within the internal auditory canal without extension into the adjacent cerebellopontine angle measuring 8 x 4 mm (previously 7 x 4 mm). As before, there is no associated mass effect upon the brain parenchyma. Redemonstrated is lace-like FLAIR hyperintensity signal in the subcortical white matter of the left middle frontal gyrus which does not enhance, has no mass effect, and appears similar to the prior study. There is also a much smaller similar-appearing focus in the right which is also stable in appearance. These are felt to most likely represent stable appearing prominent perivascular spaces with mild surrounding high T2 signal. There is no evidence of acute infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift. There are unchanged mildly low-lying cerebellar tonsils. Expected vascular flow-voids are demonstrated. The orbits, skull, and scalp soft tissues are unremarkable. Previously demonstrated mucosal thickening in the paranasal sinuses has mostly resolved. Mastoid air cells are clear.
1. The bilateral presumed vestibular schwannomas have slightly increased in size.2. Unchanged prominent perivascular spaces in the bilateral middle frontal gyri, left greater than right. 3. Unchanged mildly low-lying tonsils.