58 years, Female, diplopia, left sixth nerve palsy, rule out central cause. Brain: Examination is technically degraded due to motion, as well as using the neck coil, which was used because of patient's body habitus. There is however no evidence of restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. No intracranial mass or mass-effect. The ventricles are within normal limits in size and configuration. No abnormal parenchymal or meningeal enhancement. Major flow-voids are preserved.There is trace mucosal thickening involving the right posterior ethmoid air cells as well as bilateral maxillary sinuses. Paranasal sinuses and mastoid cells are otherwise clear. Bone marrow signal and extracranial soft tissues are within normal limits. Orbits: No intraorbital mass or abnormal enhancement. Bilateral globes are grossly unremarkable. Bilateral extraocular muscles appear within normal limits. Optic nerves demonstrate no appreciable abnormality.No lesions along the visualized course of the sixth cranial nerves are appreciated. Bilateral cavernous sinuses demonstrate symmetric, normal enhancement. No lesions involving the superior orbital fissure, clivus, or prepontine cistern.
Examination is somewhat technically degraded as described above. However, the brain and orbit MRI studies appear within normal limits. Specifically, no lesion in the brainstem or along the course of the sixth cranial nerves is appreciated.