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This is an MRI in an adolescent

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with neurofibromatosis type 2,

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and we can see enhancement

0:09

in the internal auditory canals bilaterally.

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We also see sort of,

0:14

in the right cerebellopontine angle cistern

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extending superiorly,

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this extra-axial enhancing lesion

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that has intermediate signal characteristics

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on T2 weighted imaging,

0:29

is along the margin of the inferior

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aspect of the tentorium cerebelli.

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It also is relatively hyperintense and diffusion

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weighted imaging, and it has sort of an almost a

0:46

dural tail-like appearance that we see on this.

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So, while this is in part in the right

0:55

cerebellopontine angle cistern,

0:57

this very well may represent a meningioma

1:01

in the setting of neurofibromatosis type 2.

1:04

While this is partially in the right

1:06

cerebellopontine angle cistern,

1:07

this has imaging characteristics that are suggestive

1:11

of a possible meningioma, which is

1:14

another lesion that is commonly seen in

1:16

the setting of neurofibromatosis type 2.

1:18

Notice the left vestibular schwannoma

1:22

does not yet reach the porus acusticus.

1:25

Therefore, there's no extension to

1:27

the cerebellopontine angle cistern,

1:29

and this fairly homogeneous enhancement.

1:32

Now, this patient has other lesions.

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There's an enhancing lesion here,

1:38

which is along the inferior aspect of the

1:42

tentorium and adjacent to the junction

1:45

of the sigmoid and transverse sinus.

1:47

There's this lesion here down lower,

1:51

which also looks like a meningioma.

1:53

And then in the right lateral medullary cistern,

1:59

we have another heterogeneous lesion that

2:01

also very well could represent a meningioma

2:05

with mass effect upon the brainstem.

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What else is it doing?

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Well, if we look on this T2 weighted image,

2:13

we're seeing hyperintense signal

2:16

in the right hemitongue.

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So, this is denervation atrophy.

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This is fatty changes in the right hemitongue

2:23

related to involvement of and around the

2:29

course of the right hypoglossal nerve,

2:31

and into the right hypoglossal canal.

2:33

Now, it's possible that there

2:35

could be a hypoglossal schwannoma.

2:38

But a lot of the other characteristics

2:40

of this look like a meningioma with a

2:42

dural tail that is not a morphology

2:45

I would expect of a hypoglossal schwannoma.

2:49

So, this patient has neurofibromatosis type 2

2:54

with several meningiomas, including ones that

3:00

are in the right cerebellopontine angle cistern,

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almost mimicking extension intracranially

3:07

of a vestibular schwannoma,

3:08

but likely representing a meningioma.

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And then also a lesion,

3:14

likely a meningioma, impacting the

3:16

right hypoglossal nerve, as evidenced by

3:18

denervation atrophy in the right hemitongue.