Clinical question: Follow-up hydrocephalus. Signs and symptoms: Headaches, tachycardia, known to have petroclival meningioma. Non-infused CT of brain:A low density extra axial mass with some bony remodeling measures 37.4-mm x 37-mm at the level of left petroclinoid. Although the density of the lesion is not typical for meningioma on this exam this finding is believed to represent patient's known meningioma. Exclude other possibilities an MRI examination is recommended. This lesion outlines mass effect and deviates the left medial aspect of the temporal lobe laterally. The mass extends into the left cerebellopontine angle and applies mass effect on the left aspect of the pons and left middle cerebellar peduncle. There is no evidence of any edema of the brain parenchyma surrounding the tumor. There is ventriculomegaly of the supratentorial ventricles and effacement of cortical sulci. Findings are suspected for hydrocephalus. Very subtle bifrontal periventricular low attenuation of brain parenchyma is suspected for transependymal exudate of CSF.There is only minimal mass effect on the fourth ventricle however the fourth ventricle is not collapsed and is still widely patent. I see no detectable mass in the quadrigeminal cistern plate or the third ventricle by the tumor. There is no evidence of intracranial hemorrhage. Calvarium is intact.
1.Obstructive hydrocephalus with suspect that transependymal exudate of CSF.2.Low-attenuation extra-axial mass at the left petroclinoid ligament with bony remodeling and associated mass effect on the left temporal lobe and extension of mass into the left cerebellopontine angle with mass effect on the pons and left middle cerebellar peduncle.3.Follow-up with an infused MRI is recommended.