New left sixth nerve palsy, rule out cavernous sinus process. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. No intraparenchymal mass or mass-effect. The ventricles are within normal limits in size and configuration. Several foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with mild chronic small vessel ischemic changes. Brain parenchyma is otherwise unremarkable for age. Minimal mucosal thickening in the paranasal sinuses. Major flow-voids are preserved.There is a 9 x 6 x 9 mm (APxTRVxCC) extra-axial enhancing lesion in the right petro clival region compatible with meningioma. This lesion appears larger compared to 8/28/2007 when it measured 3 mm in the transverse dimension, currently 6 mm. No masses are seen along the course of the left sixth nerve. Cavernous sinuses are within normal limits without evidence of thrombosis or other masses. Prominent vascular calcifications involving the cavernous carotid arteries which are better seen on recent CT. Bilateral orbits appear within normal limits.
1. No evidence of acute infarct. 2. No evidence of cavernous sinus thrombosis or other pathology involving the cavernous sinuses as questioned.3. There is an extra-axial enhancing lesion most compatible with a petroclival meningioma on the right measuring 9 x 6 x 9 mm and has enlarged since prior MRI dated 8/28/2007. No significant mass effect.