Sagittal and axial images were obtained with the addition of contrast-enhanced coronal and axial images, T1 weighted. There is no mass, mass effect or shift of midline structures. The ventricles are symmetric. There is no abnormal enhancing lesion. The craniocervical junction is within normal limits. There is no periventricular white matter disease. There is no significant atrophy. There is some minimal focal mucosal thickening versus mucus retention cyst or polyp in the left maxillary sinus. There is no extra-axial fluid collection. There is no evidence of an acute infarct.
IMPRESSION:
1. Essentially unremarkable MRI of the brain without and with contrast.
2. Incidental ovoid high signal on the T2 images in the left maxillary sinus. This may be due to focal mucosal thickening, mucus retention cyst or polyp.
MRI OF THE BRAIN WITHOUT CONTRAST:
INDICATION FOR STUDY: Headache, right arm numbness.
Sagittal and axial images were obtained. The craniocervical junction is within normal limits. The ventricles are symmetric. There is no mass, mass effect, or shift of midline structures. The IACs are symmetric. There is no extra-axial fluid collection. There is no abnormal area of high signal intensity on the T2 or FLAIR weighted sequences. The visualized sinuses are clear.
IMPRESSION: Unremarkable MRI of the brain. MRI of the cervical spine may be of value in light of the history of right arm numbness, if clinically warranted.
MRI OF THE BRAIN WITHOUT AND WITH CONTRAST:
INDICATION FOR STUDY: Seizures.
Multiplanar images were obtained. The cerebellar tonsils are low-lying, extending 7 mm into the upper cervical spine based on a line drawn from the base of the clivus to the occiput. There is no obvious syrinx in the upper cervical spine. There is no hydrocephalus. There is no mass, mass effect, or shift of midline structures. There is no abnormal enhancing lesion. There is no extra-axial fluid collection. There is no evidence of acute infarct. The cerebellar tonsils are not pointed inferiorly.
IMPRESSION:
1. The cerebellar tonsils are low-lying, 7 mm below the line drawn from the base of the clivus to the occiput. They are not pointed however. There is no obvious syrinx in the upper cervical spine. There is no hydrocephalus.
2. The remainder of the MRI of the brain without and with contrast is normal, within normal limits.
MRI OF THE BRAIN/IACs WITHOUT AND WITH CONTRAST:
INDICATION FOR STUDY: Bilateral hearing loss, left more than right, one month. History of respiratory infection one month ago, that is when hearing loss started. Short-term memory loss, one month ago as well.
TECHNIQUE AND FINDINGS: Multiplanar images were obtained without and with contrast. The craniocervical junction is within normal limits. In the region of the IACs, there is no abnormal enhancing lesion. Bilaterally, there is marked high signal in the mastoid air cells. This is suggestive of an infectious/inflammatory process.
In the inferior right maxillary sinus, there is a less than 1 cm round area of high signal on T2 and FLAIR sequences suggestive of a mucus-retention cyst, polyp, or focal mucosal thickening.
On the FLAIR sequences, there is slight high signal in the fourth ventricle. This is probably artifactual that is sometimes seen in midline. This area appears low signal on contrast-enhanced T1 images.
There is no mass, mass effect, or shift of midline structures. There is no extra-axial fluid collection. There is no infarct.
IMPRESSION:
1. There is marked abnormal increased signal in the mastoid air cells bilaterally suggestive of an infectious/inflammatory-type process seen on the FLAIR and T2 weighted sequences. This is abnormal.
2. There is very minimal right maxillary sinus disease inferiorly.
3. There is no abnormal enhancing lesion in the region of the internal auditory canals.
MRI OF THE BRAIN WITHOUT CONTRAST INCLUDING AN MRV:
Multiplanar images were obtained. Additionally, an MRV was obtained of the venous system.
The craniocervical junction is within normal limits. There is some atrophy of the sulci, and ventricles are prominent. The lateral ventricles are prominent as well as slight prominence of the third ventricle. The temporal horns of the lateral ventricle are not prominent. There is suggestion of a prior infarct involving the posterior left high parietal region, as there is a large area of encephalomalacic change. The sulci are quite prominent suggestive of some atrophy. There is no extra-axial fluid collection. There is no mass, mass effect, or shift of midline structures. There is some high signal on the FLAIR sequences in the third ventricle as well as just posterior to third ventricle.
On the sagittal FLAIR sequences, this is less well identifiable. The pineal gland region appears unremarkable. This may be some artifact on the axial FLAIR images. There is also some high signal in the right transverse process on the FLAIR axial sequences.
An MRV was performed and raw data and composite images are available using 3D technique. The right transverse sinus does have flow within it; however, it does appear to be slightly less than that of the left. Low flow may have accounted for the findings on the FLAIR sequences. There is no obvious evidence of an acute infarct.
IMPRESSION:
1. Atrophy and prominent ventricular system.
2. The high signal of the right transverse process appears to be due to some slow flow compared with that of the left. The right transverse process is smaller and more difficult to appreciate than the left but does appear to have flow within it on the MRV.
3. Some incidental high signal on the FLAIR axial images in the third ventricle and posterior third ventricle that is difficult to confirm on the sagittal FLAIR images, probably represents some type of artifact as it is quite midline. There is no evidence of a pineal cyst.
