69-year-old female with right ear hearing loss and vertigo. Brain MRI:There is no evidence of acute infarct. Multiple foci of susceptibility in a predominately peripheral distribution in the bilateral cerebral hemispheres have corresponding peripheral enhancement measuring less than 1 cm, and correspond to calcifications seen on prior CT, although a few foci are seen along the deep gray nuclei particularly including the right caudate and right thalamus. There is no significant surrounding FLAIR signal abnormality or restricted diffusion. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. A few small lymph nodes are seen in the right posterior cervical scalp which may be reactive. Incidental empty sella is noted.Brain IACs:Limited study since the 3D T2 sequence is of a large field of view. Additional sequences are also limited by motion. There is prominent fluid involving the right mastoid air cells and extending into the middle ear cavity. The left mastoid air cells and IACs are unremarkable. The internal auditory canals are symmetrical and normal in size and signal intensity. The inner ears are grossly normal. No abnormal mass or abnormal enhancement is seen within the cerebellopontine angle, cisterns bilaterally or within the internal auditory canals.
1.Multifocal, multiple small ring-enhancing supratentorial parenchymal lesions with susceptibility that correspond with round coarse calcification seen on the prior CT. Findings are suspicious for either the late granular nodular stage of neurocysticercosis, or early nodular calcified stage given the coinciding enhancement and calcification pattern. No surrounding parenchymal edema.2.Prominent fluid involving the right mastoid air cells and right middle ear cavity, which is nonspecific. Please correlate clinically.