Female, 68 years old, with history of childhood radiation and enlarged parapharyngeal nerve sheath tumor, now with hypercalcemia, hyperparathyroidism, and memory issues. History of thyroidectomy. Brain:A lesion with bubbly central T2 hyperintensity and a rim of hemosiderin in the left anterior temporal lobe is not significantly changed. A small associated developmental venous anomaly is not as well seen on today's examination.An additional suspected developmental venous anomaly is redemonstrated in the right superior frontal gyrus showing no significant change. No new pathologic enhancement is detected. No parenchymal edema or significant mass effect is seen. A few scattered small foci of white matter T2 hyperintensity are similar to prior and nonspecific. No new intracranial hemorrhage or abnormal extra-axial fluid is detected. The ventricles are normal in size and morphology.Neck:Again seen is a lobular, well-circumscribed, T2 hyperintense enhancing mass which principally occupies the right carotid and parapharyngeal spaces. There has been no significant interval change in the size of this lesion which measures up to 41 mm in maximal dimension. As before, the lesion displaces the internal carotid artery anteriorly and medially but the flow void is preserved compatible with patency. The internal jugular vein is compressed. The right vertebral artery passes along and possibly through the medial aspect of this lesion. The lesion infiltrates the right prevertebral space with extension through the chronically widened right C1-occipital foramen. The lesion occupies the epidural space at this level but does not significantly encroach upon the spinal canal.A subcentimeter mildly enhancing nodule within the right cerebellar medullary angle is also unchanged. No new lesions are seen. No pathologic adenopathy is detected in the neck. The salivary glands are unremarkable. The thyroid is not visualized compatible with thyroidectomy.
1.No significant change in the size of a presumed nerve sheath tumor involving the right parapharyngeal, carotid, and prevertebral spaces.2.No significant change in the size of a subcentimeter additional presumed nerve sheath tumor at the right cerebello-medullary angle.3.Stable appearing left anterior temporal cavernous malformation with associated developmental venous anomaly.