8-year-old male with neurofibromatosis type I. Assess for change of known brainstem tumor or optic glioma. BRAIN:The ill-defined foci of T2-hyperintensity involving the globus pallidi and thalami are unchanged. Similar lesions involving the middle cerebellar peduncles, cerebellar deep gray nuclei/white-matter and pons are not significantly changed. These lesions are not associated with mass-effect, consistent with FASI of neurofibromatosis.The hypothalamic mass which abuts the posterior aspect of the optic chiasm and the anterior aspect of the mamillary bodies is not significantly changed since the previous examination, accounting for different slice selection. In the axial plane, it measures 15 mm x 10 mm. The optic nerves themselves are not affected apart from the abutment described.The T2-hyperintense, T1-hypointense lesion involving the lower medulla and upper cervical spine is improved since the previous examination as well as the associated expansion. The mass is difficult to measure given its infiltrative nature. On axial T2 weighted imaging, the abnormality measures 10 mm x 8 mm (series number 1801, image #27) compared to 18 mm x 9 mm (series #701, image #22) given near complete resolution of the T2-hyperintense component along the left posterolateral aspect of the signal abnormality. Contrast enhancement characteristics of the lesion cannot be assessed given the noncontrast enhanced nature of the examination as requested.The remainder of the brain shows no abnormality. The ventricles and CSF-containing spaces are normal in size. There is no midline shift. The major intracranial vascular flow voids are preserved. Minimal ethmoid and maxillary mucosal thickening is nonspecific. Enlargement of the adenoids is a common finding at this age group.ORBITS:The minimal, focal contrast enhancement within the hypothalamic mass just superior to the attachment of the pituitary infundibulum is improved compared to the previous examination but this is nonspecific. The 3-mm well-circumscribed, T2 hyperintense lesion just inferior to the left optic nerve in the region of the left orbital apex is unchanged to minimally smaller. It shows less pronounced contrast enhancement currently. Orbits and globes are otherwise unremarkable. The optic chiasm is normal. Optic tracts appear unremarkable. CERVICAL SPINE:Focal expansion and increased T2 signal involving the left C4 and C5 nerve roots extending to just outside the also mildly expanded neural foramina is unchanged since the previous examination. Left C5 nerve root involvement as associated with a small intradural component which mildly deforms the left side of the spinal cord, as before.Alignment of the cervical spine is normal for straightening which may reflect patient positioning. The vertebral bodies are preserved in height. There is no suspicious marrow signal abnormality. Disc T2 signal and heights are preserved. There is also preservation of the spinal canal. Other than involvement of the upper part of the cervical spinal cord by the cervicomedullary infiltrative, mildly expansile mass, the cervical spinal cord shows no significant abnormality.Minimal expansion of the upper thoracic spinal central canal is not entirely included but was present previously and appears grossly similar.
1.The infiltrative mass at the cervicomedullary junction is slightly smaller, with reduced left posterolateral component. The interval decreased size is more conspicuous when compared to more remote prior exams.2.The hypothalamic mass is unchanged in size since the previous examination.3.FASI in the brain's deep gray nuclei and white-matter are unchanged.4.Expansion of the left C4 and C5 nerve roots is unchanged nor the associated mild mass-effect on the left lateral aspect of the spinal cord by the left C5 nerve root. 5.Mild expansion of the upper thoracic spinal central canal is only partially included but was present previously, grossly similar.6.Tiny, T2-hyperintense left orbital intraconal lesion is of uncertain etiology, although with decreased enhancement on current exam.