Diagnosis: DiplopiaClinical question: eval for CNS lymphomaSigns and Symptoms: diplopia, hx of B-Cell lymphoma There is an ill-defined enhancing lesion present which surrounds the frontal horn of the right lateral ventricle and has a patchy spinal extension to the adjacent periventricular white matter extending towards the subcortical white matter of the right inferior frontal gyrus - pars orbitalis. There is a punctate focus of susceptibility effect present along the right inferior frontal gyrus pars orbitalis. The lesion is predominantly hyperintense on FLAIR and hypointense on T1.There is a second focus of contrast enhancement along the medial aspect of the left temporal lobe along the subcortical white matter of the left uncus with some extension posteriorly. The lesion is predominantly hyperintense on FLAIR and hypointense on T1.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate some mucosal thickening. The visualized portions of the mastoid air cells are partially opacified. The visualized portions of the orbits are intact.
There are at least 2 lesions present within the brain parenchyma. One is centered in the right frontal horn periventricular white matter extending to the subcortical white matter of the right pars orbitalis and one center along the medial aspect of the left temporal lobe. Given the patient's history of lymphoma, CNS lymphoma is a consideration here.