HISTORY: Asymmetric hearing loss.
MRI of the IACs was taken with and without contrast, thin sections, in coronal and axial images. Images through the whole head were also performed, both pre and postcontrast.
There is no evidence of an enhancing schwannoma or acoustic neuroma in the area of either internal auditory canal or the cerebellopontine angle. We do, however, see significant left mastoiditis and edema, which involves not only the mastoid air cells but the middle ear structures as well.
Today's examination also suggests two small white matter areas of demyelination on the FLAIR images in the gray-white matter junction of the right cerebral hemisphere involving the parietooccipital region, behind the posterior horn of the lateral ventricle and one in the superior aspect of the right parietal region. Both of these measure about 3 to 6 mm and do not enhance. These are most likely areas of demyelination and small vessel insult.
There is no abnormal enhancement noted, not only in the cerebellopontine angle and IAC regions but throughout the remainder of the head. Images through the whole head were also performed and do not show suspicious change.
There is a mild and diffuse amount of atrophy noted on the exam. Some mild enlargement of the ventricles is also seen, but it is quite minimal. The craniocervical junction on the lateral sagittal images is intact and does not present with a Chiari malformation.
IMPRESSION:
1. There is no evidence of a tumor, which enhances or nonenhancing in the internal auditory canal or cerebellopontine angle bilaterally.
2. No abnormal enhancement is noted throughout the exam.
3. There is abnormal presumed mucosal inflammation and edema suggested in the left mastoid air cells and including the left middle ear cavity suggestive of significant inflammation.
4. Two small areas of demyelination suggested in the right gray-white matter junction region of the superior parietal and then the parietooccipital region. These are most likely very small vessel insults. Again, they do not enhance.
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