Questionable hemorrhage on CT status post fall. History of extra-axial mass likely meningioma. No evidence of acute traumatic intracranial hemorrhage. Focus of increased density in the left pons on CT therefore represents mineralization. Punctate focus of restricted diffusion in the right cerebellar vermis compatible with a small acute infarct. New focus of mild diffusion restriction in the right anterior frontal lobe white matter with mild increased T2 signal compatible with an acute to subacute infarct. There is a third focus of new T2 signal abnormality in the left frontal corona radiata with associated susceptibility which does not currently demonstrate diffusion restriction and is compatible with a subacute to chronic infarct with associated chronic microhemorrhage.There are additional foci of periventricular and subcortical white matter T2 signal abnormality that are similar to prior compatible with small vessel ischemic changes. Stable chronic lacunar infarct in the right caudate head.Redemonstration of an extra-axial mass centered along the right aspect of the prepontine cistern and extending down to the level the pontomedullary junction. Stable extension into an expanded right Meckel's cave and foramen ovale. The mass abuts the cavernous sinus anteriorly. There is significant mass effect on the right cerebral peduncle, pons, and the right middle cerebellar peduncle. Overall the mass is not significantly changed in size measuring 2.6 x 2.0 cm in maximum axial dimension, previously 2.9 x 1.8 cm. There is increased T2 signal in the adjacent pons which may reflect edema and/or gliosis and similar to prior.The ventricles and basal cisterns are normal in size and configuration. The expected intracranial vascular flow voids are present.The paranasal sinuses are clear. The visualized mastoid air cells are clear. The orbits are unremarkable.
1. Punctate focus of acute infarct involving the right cerebellar vermis as well as an acute to subacute punctate infarct in the right frontal lobe. There is also a focus of microhemorrhage with associated gliosis in the left frontal corona radiata which appears chronic but is new since prior study from 8/18/2015.2. Stable appearance of extra-axial mass centered in the right prepontine cistern with extensive mass effect on the adjacent pons and extension into Meckel's most compatible with a schwannoma or meningioma.3. Minimal chronic small vessel ischemic changes in the cerebral white matter and a chronic right basal ganglia infarct.4. Punctate focus of hyperdensity in the left pons as seen on recent CT is consistent with calcification.Findings were discussed with Dr. Gulati in the emergency room at 13:51