12 years, Female, evaluate for intracranial mass or intraorbital mass. Severe headaches and history of neuroblastoma. MRI brain: A single focus of T2/FLAIR hyperintensity (series 701, image 10) is unchanged within the right temporal lobe subcortical white matter with no associated restricted diffusion, enhancement, susceptibility or mass effect. No new suspicious lesions are identified.No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. The ventricles are within normal limits in size and configuration. No abnormal leptomeningeal enhancement. Major flow-voids are preserved. Empty sella is not identified. There is also mild mucosal thickening in scattered paranasal sinuses.MRI Orbits: There is subtle flattening of the posterior aspects of the globes at the optic nerve head insertion. Although there is no frank optic nerve head elevation, there is questioned punctate enhancement at the optic nerve heads. Artifact on diffusion-weighted images limits evaluation for associated optic nerve head restriction. There is also mild fluid distention of the distal optic nerve sheath which is nonspecific. Grossly, mild flattening of the posterior globes was noted on the prior exam.No abnormal orbital mass or other abnormal enhancement is seen. No abnormal signal intensity is evident. The optic nerves are normal in size and signal intensity, and are symmetric bilaterally. No retrobulbar mass, chiasmatic mass, or parasellar abnormality is seen. Extraocular muscles are unremarkable.
1. Stable to slightly decreased conspicuity of nonspecific nonenhancing T2 hyperintense right temporal lobe white matter lesion. No abnormal parenchymal enhancement or new abnormal signal.2. Slight flattening of the posterior aspects of the globes at the optic nerve head insertion without frank elevation of the optic nerve head, although there is punctate enhancement suggested and slight fluid distention of the optic nerve sheath distally. The flattening of the posterior globes is grossly similar to prior exam, although correlation with ophthalmological exam is recommended to assess for papilledema, and consideration may be made for lumbar puncture. If further assessment is needed of cranial nerves to evaluate exotropia, MRI of the cranial nerves may be obtained. No evidence of associated empty sella to suggest pseudotumor cerebri.Dr. Yang discussed these findings over the telephone with Dr. JAMES W. MITCHELL on 10/4/2016 9:00 AM.