Clinical question: Evaluate for new stroke or mass lesion. Signs and symptoms: Transient episodes of vomiting and confusion with right hand tremor. Nonenhanced brain MRI:Diffusion weighted images demonstrate no evidence of an acute ischemic stroke.Examination demonstrate mild degree of chronic small vessel ischemic strokes involving the subcortical and periventricular white matter of the cerebral hemispheres and minimally of bilateral basal ganglia as well as pons. There is no convincing evidence of any appreciable significant change in the extent of disease since prior exam from 2014.Ventricular system remains within normal size and with maintained midline. Slight prominence of cortical sulci appears similar to prior exam.There is a well-demarcated extra axial T2 hypointense mass along the anterior aspect of the left middle cranial fossa highly suggestive of a small meningioma and without change since prior exam. On this exam there is no appreciable mass effect with this finding and the adjacent brain parenchyma in the streets no signal changes to suggest edema.The signal void of major intracranial arterial branches are identified.Unremarkable images through the orbits, paranasal sinuses, mastoid air cells, calvarium and soft tissues of the scalp.
1.No acute intracranial process.2.Findings of mild chronic nonhemorrhagic small vessel ischemic strokes without convincing evidence of change since prior exam from 2014.3.Small extra axial left anterior middle cranial fossa likely representing a meningioma without change since prior studies.