40 year-old male status post flap for rhabdomyosarcoma on back with syncope x 2. History of neurofibromatosis. Please evaluate if neurofibroma intracranially are present to explain the syncope. Syncope is not believed to be cardiac in etiology. HEAD CT:Multiple superficial neurofibromas are identified within the scalp. (image 25/32). No evidence of abnormal intracranial enhancement.The cerebral hemispheres, cerebellum and brainstem are normal in structure and attenuation. No intracranial hemorrhage, infarctions, edema or areas of mass effect are identified. No abnormal extra-axial fluid collections are identified. The ventricles are normal in volume and are midline.The visualized paranasal sinuses and mastoid air cells are normally aerated.There is a bony dehiscence between the right jugular fossa and the middle ear with an enlarged right jugular fossa. This can result in pulsatile tinnitus. Differential considerations for this finding include a normal large dominant right jugular vein secondary to a large right lateral and sigmoid sinuses, a high riding jugular fossa most likely due to the increased size of the sigmoid sinus, and a paraganglioma resulting from the pars nervosa in this location. An MRI is recommended to exclude tumor given the patient history of neurofibromatosis.
1. The right jugular fossa appears enlarged as described. An MRI of the internal auditory canal with contrast is recommended to exclude the presence of a nerve sheath tumor given the history of neurofibromatosis. Findings were discussed with Dr. Hofer following interpretation.2. No evidence of abnormal intracranial enhancing masses. 3. Superficial neurofibromas in the scalp. 