Female, 24 years old, with intermittent weakness, blurred vision, headaches, worsening over the last three days, five months of right eye blurred vision, sluggish right extraocular muscles today. Brain: Parenchymal morphology is within normal limits. No focal signal abnormality, edema or pathologic enhancement is observed. Diffusion-weighted imaging does not cover the entire brain, but that portion evaluated is free of restricted diffusion. No susceptibility weighted imaging is available. Within that limitation, no evidence of intracranial hemorrhage is seen. No abnormal extra-axial collections are detected. The ventricles are normal in size and morphology. The cerebellar tonsils descend approximately 7 mm below the level of the foramen magnum. However, there is no frank crowding at the foramen magnum.Orbits:The globes are round and symmetric. The extraocular muscles demonstrate normal morphology and enhancement. The optic nerves are free of pathologic signal abnormality and enhancement. No orbital masses are seen. An oval enhancing nodule measuring up to 10 mm is evident situated in the left lateral upper eyelid, adjacent to the lacrimal gland. There is evidence of inflammation in the surrounding soft tissues.C-spine:Alignment is anatomic. Vertebral body height and morphology are within normal limits. No pathologic marrow replacement or abnormal marrow enhancement is seen.The visualized spinal cord demonstrates normal signal intensity and morphology. No focal lesions are seen. No pathologic intramedullary or leptomeningeal enhancement is detected.The intervertebral discs are preserved. No significant spinal canal or foraminal stenosis is seen.
1.Within the study limitations as discussed above, no definite intracranial findings are seen to account for the patient's symptoms. The cerebellar tonsils do, however, descend below the foramen magnum compatible with a Chiari I malformation. The relevance of this to the patient's presenting symptoms is uncertain.2.An enhancing nodule is evident centered on the left upper outer eyelid. This lesion may be related to glandular inflammation. A neoplastic process is considered less likely though cannot be entirely excluded. Clinical follow-up is advised.3.Evaluation of the cervical spine is within normal limits. No specific findings are seen to account for the patient's symptoms.