Wk 1, Case 5 - Review

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Report

Patient History
Vision loss left eye.

Findings
Pre- and postcontrast MR was performed of the brain and orbits.

Brain: Sagittal T1-weighted images demonstrate corpus callosum to be intact. No evidence of Chiari malformation. No abnormal pineal region masses. Pituitary gland is not enlarged. Diffusion imaging demonstrates no evidence of recent infarct. Gradient-echo imaging shows no evidence of hemosiderin staining. Axial FLAIR and T2-weighted images demonstrate ill-defined areas of increased FLAIR and T2 signal involving the left basal ganglia, right side of the splenium of the corpus callosum, medial right cerebral peduncle, right anterolateral pons, and anterior 4th ventricle. Contrast-enhanced T1-weighted images show no abnormal enhancing intraaxial lesions. These findings are unchanged when compared to the prior study.

Orbits: Thin-section imaging through the optic nerves demonstrates diffuse enlargement of the optic chiasm extending posteriorly to involve the post-chiasmatic optic nerves and optic tracts with asymmetrical increased signal along the proximal postchiasmatic optic nerve tracts. No abnormal enhancement is identified. The retrobulbar segments of the optic nerves appear to be within normal limits. The postcontrast-enhanced T1-weighted images demonstrate no definite evidence of abnormal enhancement involving the right anteromedial pons and medial right cerebral peduncle. The region of Meckel's cave and cavernous sinuses appear to be within normal limits and symmetric.

Conclusions
1. Findings are consistent with neurofibromatosis type 1 associated with optic nerve glioma involving the optic chiasm extending posteriorly to involve the post-chiasmatic optic nerve radiations.
2. Multiple intraparenchymal focal areas of increased FLAIR and T2 signal which are most likely due to hamartomatous lesions typically seen in neurofibromatosis.
3. No change in the ventricular size, shape, and configuration

Case Discussion

Faculty

David M Yousem, MD, MBA

Professor of Radiology, Vice Chairman and Associate Dean

Johns Hopkins University

Suresh K Mukherji, MD, FACR, MBA

Clinical Professor, University of Illinois & Rutgers University. Faculty, Michigan State University. Director Head & Neck Radiology, ProScan Imaging

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Wk 1, Case 5 - Review