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again there are multiple metastatic lesions demonstrating mild increase in size and also larger pattern of vasogenic edema more evident on the left temporo-occipital region 4 12 also on the left frontal lobe involving the orbitary gyrus 4 10 the left cerebellar lesion also appears slightly larger and with similar pattern of vasogenic edema the lesion located in the left temporo-occipital region measures approximately 10 9 x 12 5 mm in size and on the prior measures 7 8 x 8 4 mm the left frontal lesion at the level of the orbitary gyrus measures approximately 11 7 x 11 3 mm in size and on the prior measures 7 4 x 6 0 mm the area of high signal identified on the right frontal lobe 4 10 is not enhancing a new area of abnormal enhancement is identified on the left frontal lobe inferior medial gyrus 8 14 measuring approximately 3 9 x 3 3 mm in size with minimal associated vasogenic edema post-surgical changes identified in the right opercular region unchanged since the prior examination pattern of enhancement is demonstrated in the internal capsule and caudate nucleus likely consistent with reperfusion changes in the ischemic area unchanged mild dural enhancement in the surgical bed the orbits the paranasal sinuses and the mastoid air cells are unremarkable the volumetric analysis demonstrates 254 1 cubic millimeters in the lesion identified in the posterior fossa 745 2 cubic millimeters in the left frontal lesion and 1 21 cubic centimeters in the left temporo-occipital lesion
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mild enlargement of the previously demonstrated metastatic lesions larger pattern of vasogenic edema new area of abnormal enhancement noted on the left frontal lobe possibly consistent with a new metastatic lesion and areas of abnormal enhancement demonstrated in the right internal capsule and right caudate nucleus likely consistent with reperfusion phenomenon in the prior ischemic area stable postsurgical changes identified in the right operculum the left cerebellar metastatic lesion appears slightly larger but with similar pattern of vasogenic edema
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Findings:
the previously-described right frontal metastasis has increased in size to 8 8 x 6 8 mm in the transverse and ap dimensions with accompanying increase in surrounding vasogenic edema the previously-described left frontal lesion has similarly developed increased flair- signal suggestive of increased vasogenic edema there are new multiple enhancing and flair- hyperintense lesions consistent with metastases located predominantly in the posterior fossa there are innumerable lesions within the bilateral cerebellar hemispheres not seen on the ___ scan the largest of these lesions measures 5 9 x 5 9 mm in the ap and transverse dimensions and is located in the right cerebellar hemisphere many of the cerebellar lesions are superficially-located suggesting leptomeningeal involvent and subarachnoid spread in addition three foci along the midline within the frontal lobes also suggest leptomeningeal spread 106 78 80 82 there is no vasogenic edema surrounding these new metastases also suggesting that they may reside in the subarachnoid space there also are foci of enhancement within the right parietal 6 127 and occipital 6 85 73 58 calvaria with regards to one of the occipital lobe lesions 6 58 there appears to be underlying enhancement of the leptomeninges suggestive of direct spread at that area the previously described foci of subacute infarct within the right frontal lobe and left centrum semiovale are again redemonstrated as foci of t2- and flair-hyperintensity there are also acute subacute infarctions within the pons and left frontal lobes the lesion in the left frontal lobe is adjacent to the frontal ___ of the left lateral ventricle 13 14 lesions in in the midline and left paramedian hemipons are consistent with paramedian pontine perforator infarction both of these show equivocal restricted diffusion making exact determination of their age difficult however they were not present on the prior study suggesting an early subacute timecourse the patient is status post coiling of the anterior communicating artery aneurysm without evidence of recanalization the intracranial vertebral and internal carotid arteries and their major branches appear normal without stenosis occlusion or additional aneurysm larger than 2 mm in diameter the ventricles and sulci are normal and unchanged in size and configuration there is no new hemorrhage or mass effect seen
Impression:
1 interval development of extensive metastases preferentially located within the posterior fossa many of which are quite superficial suggestive of possible leptomeningeal involvement with seeding of the subarachnoid space there is also interval increase in the size of the known right frontal metastatic lesion and identification of additional discrete foci of bony involvement beyond the previously-described osseous lesions 2 interval development of two additional likely early subacute infarcts within the white matter adjacent to the frontal ___ of the left lateral ventricle and the midline pons continued evolution of the previously-described left centrum semiovale left thalamic and right frontal infarcts 3 no evidence of recanalization of the anterior communicating artery aneurysm status post coiling with otherwise normal mra without additional aneurysm larger than 2 mm focal stenosis or occlusion
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Findings:
left occipital lobe intrinsically t1 hyperintense mass with surrounding vasogenic edema measuring 16 x 24 x 22 mm appears similar to the prior examination there is interval enlargement of a left temporal lesion on image 68 of series 11 now measuring 8 x 8 mm previously measuring 3 mm a second parietal lesion on image 53 of series 11 has also enlarged now measuring 7 x 7 mm previously visualized as a punctate region of enhancement on the prior study there are several punctate foci of abnormal enhancement within the right cerebellar hemisphere which appear similar to the prior exam as well as punctate focus in the left cerebellar hemisphere on image 38 of series 11 which appears slightly more prominent than on the prior the flair signal hyperintensity surrounding all of the left supratentorial lesions has increased compared to the prior examination there is also increased flair signal in the region of the punctate enhancing cerebellar sulci metastatic lesion in the midbrain is unchanged the susceptibility images reveal areas of blooming artifact in the left insula occipital lobe and left frontal convexity suggesting residual blood products major flow voids are maintained the orbits are unremarkable there is patchy mucosal thickening in the mastoid air cells and a mucus retention cyst in the right maxillary sinus as well as ethmoid air cell mucosal thickening there are no findings to suggest acute ischemia
Impression:
interval progression of metastatic disease with increased size of lesions in the left insula and parietal occipital lobes and increased surrounding edema surrounding both these lesions and areas of punctate enhancement within the cerebellum bilaterally dr ___ discussed the findings via telephone with dr ___ ___ at 2 38 p m on ___
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Findings:
the two lesions located at the right frontal convexity are smaller and more heterogeneous in appearance compared to the previous examination the more lateral lesion measures 12 x 12 mm previously 14 x 12 mm 11 88 a more medially located lesion measures 12 x 6 mm previously 14 x 12 mm 11 86 gradient echo imaging demonstrates focal areas of susceptibility within these lesions likely related to blood products and necrosis unchanged very minimal surrounding vasogenic edema is evident and much decreased compared to previous study 4 28 two lesions within the left frontal lobe are now barely discernable measuring 1-2 mm in size 11a 61 65 there is no discernable associated flair abnormality a right cerebellar hemisphere lesion now measures 7 x 5 mm previously 11 x 8 mm 11a 23 in addition to decreasing size of this lesion there has been interval decrease in the amount of surrounding vasogenic edema lesion located within the posterior left occipital lobe is smaller measuring 3 mm 7 mm previously 11a 38 at least two new sub-3-mm lesions are evident within the left posterior parietal lobe 9 14 13 incidental note is made a t1 hyperdense focus located within the right superior parietal lobe 3 17 there is no shift of normally midline structures there is no local mass effect from any of the lesions described slight prominence of the ventricles and sulci is stable tumor volume of right cerebellar lesion 196 mm3 tumor volume of right lateral frontal convexity lesion 732 mm3 tumor volume of medial right frontal superior convexity lesion 374 mm3 mild-to-moderate circumferential mucosal thickening within the right maxillary sinus is essentially unchanged otherwise the visualized paranasal sinuses appear well aerated a trace amount of fluid is noted within the right mastoid air cells
Impression:
1 interval decrease in size and amount of associated flair abnormality of multiple dominant lesions as detailed above 2 at least two new sub-3-mm lesions within the left parietal lobe 3 mild-to-moderate right maxillary sinus disease
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Findings:
today's exam is compared with the prior from ___ since that examination there has been progression in the size of the right cerebellar and posterior right frontal enhancing lesions the right cerebellar lesion now measures 9 x 13 mm and the posterior right frontal lesion measures 11 x 12 mm this posterior right frontal lesion is located within the pre-central gyrus and has a large amount of worsening vasogenic edema this vasogenic edema involves both the pre-central and post-central gyri these findings are superimposed upon a large amount of increased t2 signal within the periventricular white matter likely due to post-treatment effects such as could occur from chemotherapy or radiation no new enhancing lesions are identified there is no evidence of slow diffusion to indicate an acute infarct the post-surgical bed in the left parietooccipital region appears improved with no significant enhancement at this margin of the surgical cavity there is no midline shift no hydrocephalus is noted there are multiple lacunes within the basal ganglia and thalami bilaterally there is mastoid sinus opacification on the right as before the left mastoid sinus fluid has cleared these findings were communicated to dr ___ ___ by telephone at the time of dictation
Impression:
progression of the right cerebellar and posterior right frontal metastases there is no evidence of hydrocephalus or compression of the fourth ventricle worsening vasogenic edema within the right pre-central gyrus and extending into the post-central gyrus extensive t2 hyperintensities in the cerebral white matter as before due to prior radiation or chemotherapy dr ___ ___ ___
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the current examination demonstrates increased signal in both thalamic region as well as in the perirolandic region on diffusion and flair images these findings are consistent with anoxic brain injury in addition there is subtle increased signal identified in the cerebellum with bilateral patchy areas of low signal on adc map these findings are suspicious for infarcts in both cerebellar regions there is no midline shift or hydrocephalus identified following gadolinium no abnormal enhancement is seen
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1 bilateral thalamic hyperintensities with low signal on adc indicative of ischemia high signal in the perirolandic region bilaterally the combination of changes are suggestive of hypoxic brain injury slow diffusion is seen bilaterally in the cerebellar hemispheres suspicious for infarcts no abnormal enhancement mucosal changes in the sinuses could be due to intubation the changes described are newly apparent since previous study
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Findings:
there is no evidence of acute infarct seen on diffusion-weighted images there is prominence of ventricles and sulci indicating brain atrophy there is mild medial temporal atrophy seen brain atrophy is inappropriate for patient's age there is no midline shift or hydrocephalus a chronic left cerebellar infarct is identified following gadolinium there is no evidence of abnormal parenchymal vascular or meningeal enhancement seen
Impression:
no acute infarct seen age-inappropriate brain atrophy small chronic left cerebellar infarct no mass effect or hydrocephalus no enhancing brain lesions
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Findings:
there is no evidence of acute infarct seen on diffusion images a chronic left basal ganglia and thalamic infarct is identified as seen on the previous ct of ___ and mri of ___ there is moderate prominence of ventricles and sulci indicating brain atrophy a chronic left cerebellar infarct is also identified there is no midline shift or hydrocephalus seen there are moderate periventricular changes of small vessel disease identified the suprasellar and craniocervical regions are normal on the sagittal images
Impression:
no evidence of acute infarct chronic left basal ganglia and thalamic infarcts and chronic left cerebellar infarct moderate brain atrophy and small vessel disease
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Findings:
encephalomalacia from left pca infarct in the medial left occipital and temporal lobes and extending into the posterior left thalamus is similar to the recent ct other chronic findings include a small cortical infarct in the left cerebellar hemisphere and punctate likely lacunar infarct in the right cerebellar hemisphere scattered foci of susceptibility most prominent within the cerebellum may represent tiny chronic microhemorrhages or small calcifications there is no evidence of acute infarct hemorrhage or mass effect extensive flair t2 hyperintense signal within the cerebral white matter may represent advanced microvascular disease besides the chronic infarct in the left thalamus the central ___ matter structures have normal signal there is mildly heterogeneous low marrow signal on the t1 weighted images which may represent red marrow hyperplasia or could be secondary to the patient's chronic medical problems
Impression:
1 no evidence of acute hemorrhage acute infarct or mass effect 2 extensive flair t2 hyperintensity within the cerebral white matter this most likely represents advanced microvascular disease sparing of the central ___ matter makes metabolic processes less likely 3 large chronic left pca infarct similar to prior other details as above
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Findings:
focal areas of high attenuation are seen within the mid brain and in the left thalamus this likely represents the acute blood seen on mri there is a adjacent area of low attenuation in the region of the left thalamic bleed there is decreased attenuation in the periventricular white matter and cortex of the left occipital and temporal lobes additional foci of decreased attenuation are present within the left cerebellar hemisphere the findings are consistent with the posterior circulation distribution stroke seen on mri diffusion weighted sequences no new subarachnoid blood is identified at this time there is no hydrocephalus or shift of normally midline structures there is mass effect in the area of the evolving infarct
Impression:
evolving posterior circulation infarct affecting the left occipital lobe temporal lobe cerebellum mid brain and thalamus foci of high attenuation likely representing hemorrhage in the left thalamus and mid brain as seen on prior mri findings were discussed with dr ___ ___ at the time the study was performed
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again noted is the large intraparenchymal hematoma in the right cerebral hemisphere in the frontoparietal and temporal lobes with mild mass effect on the adjacent body of the right lateral ventricle multiple flair hyperintense areas are noted in the white matter some of which likely represent sequelae of chronic small vessel occlusive disease and the foci adjacent to the hematoma are related to the adjacent vasogenic edema there are a few flair hyperintense areas in the pons which may represent sequelae of chronic small vessel occlusive disease however there is no definite area of of increased signal on the dwi sequence with corresponding abnormality on the adc sequence to suggest acute infarct no significant change is noted in the appearance of the pons on the diffusion sequences compared to the prior study a few dark areas noted in the adc sequence in the anterior pons are noted on the study before as well and likely represent areas of sequelae of chronic small vessel occlusive disease no lesions hyperintense enough are noted on the diffusion sequence to suggest an acute infarct no new areas of hemorrhage are noted prominent ventricles and extra-axial csf spaces are noted consistent with age-appropriate involution of the brain parenchyma
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1 unchanged large right intraparenchymal hematoma in the right cerebral hemisphere with mild mass effect 2 no definite focus of restricted diffusion in the pons to suggest acute infarct however to correlate with clinical findings as dwi is less sensitive for brainstem infarctions
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Findings:
there is now a new area of restricted diffusion seen in the right posterior temporal lobe extending to the occipital lobe indicative of an acute infarct additional diffusion abnormalities are also seen in the posterior portion of the right insula and also in the right parietal subcortical region which also demonstrate low adc indicative of acute infarcts the previously identified acute infarcts in the left cerebral hemisphere are also seen however adc in this level has increased now they appear isointense there is enhancement seen in this region indicative of subacute infarcts there are multiple hyperintensities in the white matter indicative of small vessel disease there is also diffuse hyperintensities in the brainstem likely due to small vessel disease chronic basal ganglia and white matter lacunes are also identified there is ex vacuo dilatation of the right temporal ___ and occipital ___ due to a chronic right occipital lobe infarct there are no other areas of abnormal enhancement seen within the brain
Impression:
1 acute infarcts are seen in the right posterior temporal and occipital lobe and right parietal lobe since the previous mri of ___ 2 previously noted infarcts in the left posterior frontoparietal region have evolved and now demonstrate enhancement 3 chronic right occipital infarct identified 4 moderate-to-severe changes of small vessel disease and brain atrophy are seen 5 extensive soft tissue changes are identified within the mastoid air cells which could be due to intubation
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Findings:
there is a large area of intraparenchymal hematoma isointense on t1 and hypointense on the t2-weighted images representing acute hemorrhage on correlation with the recent ct scans with no significant change in the size of the hematoma itself there is moderate perilesional edema around the hematoma there is mass effect on the atrium of the right lateral ventricle from the hematoma in addition on the flair sequence there is increased signal in the cerebral sulci right more and left which may be related to subarachnoid hemorrhage there are a few scattered flair hyperintense foci in the cerebral white matter on both sides likely representing sequela of chronic small vessel occlusive disease a small t2 hyperintense focus suppressed on the flair sequence in right cerebellar hemisphere can represent a focus of chronic infarction malacic changes or gliosis series 8 image 7 the post-contrast sequences are significantly limited due to motion artifacts no definite enhancement is noted within the hematoma itself however assessment is somewhat limited due to the pre-contrast areas of hyperintensity within the hematoma however underlying vascular lesions can be obscured by the hematoma itself there is possible mild meningeal enhancement pachymeningeal enhancement on the right side limited in evaluation due to motion artifacts the ventricles are mildly prominent which might be appropriate for the patient's age and correlation with parenchymal volume loss
Impression:
1 acute intraparenchymal hematoma in the right parietal lobe parasagittal in location mild mass effect on the atrium of the right lateral ventricle 2 no definite enhancement is noted within the hematoma itself however an underlying vascular lesion cannot be excluded to consider repeating the study with routine mr head without and with contrast and mr angiogram of the head for further assessment after resolution of the hematoma 3 increased flair signal in the cerebral sulci on the right side which could be related to subarachnoid hemorrhage in the right frontal and temporal lobes as noted on the recent ct done on ___
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Findings:
"the study is compared with the ___ nect obtained some 13 hours earlier there is a solitary well-defined approximately 11 mm ap focus of slow diffusion in right paramedian frontovertex cortex with corresponding adc map hypo- and relatively faint ___ 7 8 19 19-22 this represents a relatively acute cortical infarct there is no evidence of acute infarction elsewhere there is no evidence of hemorrhage at this site and no intra-or extra-axial hemorrhage elsewhere there are scattered both punctate and confluent flair-hyperintensities in bihemispheric subcortical and periventricular white matter likely the sequelae of chronic small vessel ischemic disease the principal intracranial vascular flow-voids are preserved see mra below including those of the dural venous sinuses and these structures enhance normally there is no pathologic parenchymal leptomeningeal or dural focus of enhancement including at the site of infarction above the sella parasellar region and remainder of the skull base and orbits are unremarkable there is minimal mucosal thickening in scattered anterior ethmoidal air cells there is normal flow-related enhancement in the included intracranial portions of both internal carotid and proximal middle and anterior cerebral arteries with normal symmetric arborization of mca branches and no significant mural irregularity or flow-limiting stenosis there is normal flow-related enhancement in somewhat tortuous co-dominant distal vertebral arteries and in the basilar and bilateral superior cerebellar and posterior cerebral arteries with no significant mural irregularity or flow-limiting stenosis incidentally noted is a ""patulous"" basilar summit including an infundibular origin of the left pca anterior and bilateral posterior communicating vessels are identified with no aneurysm larger than 3 mm the largely included aortic arch and great vessel origins are unremarkable with no flow-limiting stenosis the common and cervical internal and external carotid arteries are normal in course caliber contour and enhancement with no significant mural irregularity flow-limiting stenosis or evidence of dissection the co-dominant vertebral arteries are normal in course caliber contour and enhancement with no significant mural irregularity flow-limiting stenosis or evidence of dissection"
Impression:
1 small relatively acute infarct involving the right frontovertex cortex likely accounting for the patient's acute presentation 2 no evidence of acute infarction and no hemorrhage elsewhere 3 sequelae of chronic small vessel ischemic disease likely related to the given history of hypertension 4 no pathologic focus of enhancement 5 unremarkable cranial and cervical mra with no significant mural irregularity flow-limiting stenosis evidence of dissection or aneurysm larger than 3 mm
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Findings:
on the axial flair sequence there are multiple small flair hyperintense foci in the periventricular and subcortical white matter on both sides in the frontal and the parietal lobes as well as the occipital lobes which may relate to sequelae of chronic small vessel occlusive disease in addition there is a large 1 5 x 1 2 cm focus with csf signal intensity on all sequences in the left periventricular white matter which can represent a prominent perivascular space or a chronic lacunar infarct more likely the former given the signal characteristics moderately dilated ventricles along with prominent sylvian fissures are noted as well as prominent cerebral sulci are noted and relate to volume loss the fluid signal inversion is suboptimal on the flair sequence however there is no evidence of subarachnoid hemorrhage on the most recent ct study the left vertebral artery is dominant on the axial t2-weighted images the flow void in the major intracranial arteries is visualized except the right distal vertebral artery where the flow void is not well seen this may relate to slow flow or partial thrombosis the visualized portions of the paranasal sinuses reveal mucosal thickening in the ethmoid air cells and the right side of the sphenoid sinus and minimal in the right maxillary sinus there is moderate amount of fluid and or mucosal thickening in the right mastoid air cells and minimal on the left side on the diffusion-weighted sequences there is a punctate focus of increased signal intensity on the dwi images in the left periventricular region series 702 image 23 in the frontal lobe which is too small to be accurately identified on the adc sequence and can represent a tiny acute infarct versus an artifact no surrounding edema or mass effect is noted
Impression:
1 loss of flow void in the right distal vertebral artery which may relate to slow flow or partial thrombosis further evaluation with mr angiogram of the head punctate area of possible restricted diffusion related to acute infarct in the left periventricular region which is too small to be accurately characterized this can otherwise represent an artifact no surrounding mass effect or edema is noted findings were discussed with dr ___ hickman by dr ___ on ___
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there is a surgical defect in the right posterior frontal lobe and extending into the corpus callosum there is residual air in this location minimal enhancement is identified at the surgical site the appearance of these changes is stable since the previous study no new areas of abnormal signal or enhancement are identified within the brain there si no diffusion signal abnormality to indicate infarction the ventricles are not dilated there is no change in the degree of mass effect associated with the right posterior frontal lobe abnormality
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stable appearance of the brain since the previous study of ___ no evidence of acute infarction
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Findings:
there has been resection of a left frontal lobe enhancing mass blood fluid and air are observed in the cavity there is minimal enhancement along the margins of the surgical site dural enhancement is also identified these may be reactive changes there is residual edema in the remaining left frontal lobe posterior to the surgical defect and extending into the anterior aspect of the corpus callosum on the left in some of these locations especially medially and inferiorly there is diffusion signal hyperintensity the nature and significance of this finding is unclear at this time no other areas of abnormal signal or enhancement are detected within the brain the ventricles are not dilated there is no shift of normally midline structures flow signal is observed in the proximal branches of the circle of ___
Impression:
baseline postoperative examination following resection of a left frontal lobe tumor dfdgf
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Findings:
since the previous mri study the patient has undergone right frontal craniotomy for resection of enhancing mass lesion identified adjacent to the right side of the corpus callosum and right frontal region compared to previous study blood products are seen within the surgical region with surrounding edema air is seen within the right frontal region no distinct residual area of enhancement is identified mild mass effect is seen in the right lateral ventricle unchanged from the previous study on diffusion images evidence of increased signal is identified along the splenium of corpus callosum and along the margin of the posterior portion of the body of the right lateral ventricle these findings are suspicious for restricted diffusion and could indicate ischemia in the region adjacent to the surgery
Impression:
status post resection of right frontal pericallosal enhancing mass lesion blood products and air are seen in the right frontal region at the site of surgery no residual enhancing mass identified increased signal adjacent to the surgical site indicative of brain edema there is new restricted diffusion identified along the splenium of the corpus callosum and posterior portion of the body of right lateral ventricle which is suspicious for ischemia at the margin of surgical resection further follow up recommended
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Findings:
there is a small amount of blood and residual air in the right frontal lobe resection cavity overall post-operative changes are as expected two days after surgery there is residual hypodensity in the left anterior medial frontal lobe some of this may be edema within the brain however there is no deformity of the frontal ___ of the right lateral ventricle or change in the anatomic appearance of the brain no areas of cortical territorial infarction are visualized there is no shift of normally midline structures
Impression:
post-operative changes of the right frontal lobe without clear explanation for new neurologic change findings were discussed with dr ___ at 3 05 p m on ___ dfdgf
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Findings:
there has been further evolution of blood products and postoperative changes in the left frontal lobe compared to earlier studies the surgical cavity is smaller and the degree of residual enhancement at the surgical site is diminished there is no diffusion signal abnormality identified within the brain there are no new areas of signal abnormality or abnormal enhancement the size and shape of the ventricles is unchanged there are flow voids in the major branches of the circle of ___
Impression:
further evolution of post-surgical changes in the left frontal lobe no new mass effect
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the ventricles and extra-axial spaces are normal in size there is no evidence of midline shift mass effect or hydrocephalus there are no abnormalities seen on diffusion images or susceptibility images to indicate diffuse axonal injury no areas of brain contusion seen suprasellar and craniocervical regions are unremarkable the vascular flow voids are maintained
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no significant abnormalities on mri of the brain without gadolinium
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Findings:
the ventricles and extra-axial spaces are normal in size no evidence of midline shift mass effect or hydrocephalus is identified there are no focal signal abnormalities seen within the brain no evidence of blood products are noted following gadolinium no evidence of abnormal parenchymal vascular or meningeal enhancement is seen the suprasellar and craniocervical regions are unremarkable on the sagittal images the vascular flow voids are maintained
Impression:
normal mri of the brain with and without gadolinium
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Findings:
ventricles and extraaxial spaces are normal in size there is no evidence of midline shift mass effect or hydrocephalus noted there are no focal signal abnormalities seen within the brain no evidence of slow diffusion is noted following gadolinium no evidence of abnormal parenchymal vascular or meningeal enhancement seen
Impression:
no significant abnormalities detected in the mri of the brain with and without gadolinium
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Findings:
the ventricles and extra-axial spaces are normal in size no evidence of midline shift mass effect or hydrocephalus seen there are no focal signal abnormalities seen within the brain vascular flow voids are maintained following gadolinium no evidence of abnormal parenchymal vascular or meningeal enhancement seen
Impression:
no significant abnormalities detected on the mri of the brain with and without gadolinium
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Findings:
the ventricles and extra-axial spaces are normal in size there is no evidence of midline shift mass effect or hydrocephalus there are no territorial infarcts seen a few small foci of t2 hyperintensity are seen in the frontal subcortical white matter of nonspecific nature no evidence of acute infarct seen on diffusion images the suprasellar and craniocervical regions are normal on the sagittal images
Impression:
except for a few small nonspecific foci of t2 hyperintensity in the frontal subcortical white matter no other abnormalities are seen no evidence of mass effect midline shift hydrocephalus or acute infarcts seen
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the brain parenchyma has normal ___-white matter differentiation there is no evidence of acute infarction intracranial hemorrhage space-occupying lesion or mass effect also there are no signs of demyelination no abnormality is noted with regard to basal ganglia brainstem cerebellum and craniocervical junction the parenchymal or leptomeningeal enhancement is unremarkable the flow voids of the major intracranial vessels are preserved there is contour irregularity in the left cavernous carotid segment with a tiny foci of lobulations se 9 im9 se 12 im 9 a small csf isointense discrete mass is seen in the right posterior fossa exerting minimal mass effect on the right cerebellar hemisphere and measuring approximately 15 x 11 mm in axial plane the finding is consistent with a subarachnoid cyst bilateral retention cysts are seen at the floor of the maxillary sinus the mastoid air cells are clear the orbits and osseous structures are unremarkable
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1 small csf isointense discrete mass in the right posterior fossa likely representing a subarachnoid cyst no enhancing lesions in the brain 2 slightly lobulated focus of contour irregularity of left cavernous carotid segment-correlate with mra head without contrast 2 bilateral small retention cysts involving the maxillary sinus
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Findings:
the patient is status post resection of right frontal lobe lesion with expected changes and surrounding flair signal abnormality likely gliosis and encephalomalacia given the absence of new nodular enhancement there is no evidence of local recurrence likewise no new parenchymal lesions are identified extensive dural thickening and enhancement along the frontal lobe is unchanged likely postoperative in nature the same is true for increased signal of the frontal sinus which is extending into the superior ethmoid cells and stable since surgery the ___-white matter differentiation of the brain parenchyma is well preserved and there is no evidence of infarct intracranial hemorrhage space-occupying lesion or mass effect flow voids of the major intracranial vessels are preserved with dominant and tortuous left vertebral artery mild contour irregularity of the cavernous carotid segments is noted the cerebral sulci ventricles and extra-axial csf-containing spaces have normal size and configuration the mastoid air cells are clear the ocular lenses are not seen
Impression:
1 stable postoperative changes with increased signal of the frontal sinus dural thickening encephalomalacia and gliosis- attention on close followup no evidence of nodular enhancement in the brain to suggest a parenchymal metastatic lesion 2 no new metastatic lesions
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Findings:
the brain parenchyma appears normal there is no evidence of acute infarct space occupying lesion or intracranial hemorrhage the ventricles extra-axial csf spaces and cortical sulci appear normal the right temporal ___ is more prominent than left and is unchanged since the prior study there is no abnormal dural leptomeningeal or parenchymal enhancement brainstem and cerebellum appear normal few scattered foci of t2 and flair hyperintensities are noted in subcortical white matter of bilateral frontal and parietal lobes which are non specific and likely represents changes of chronic small vessel ischemic disease these are unchanged since the prior study major intracranial flow voids are noted mild mucosal thickening is noted in the sphenoid sinus rest of the visualized paranasal sinuses and mastoid air cells are clear the orbits and osseous structures are unremarkable thornwaldt cyst is noted in the nasopharynx a few cystic foci are noted in the adenoids
Impression:
1 no obvious focal lesions to suggest metastasis non-specific flair hyperintense foci in the brain parenchyma as above
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Findings:
the brain parenchyma appears normal there is no evidence of acute infarct intracranial hemorrhage or space-occupying lesion scattered foci of flair hyperintensities are noted in periventricular and subcortical white matter of bilateral cerebral hemispheres and in the pons which likely represent changes of chronic small vessel ischemic disease the ventricles extra-axial csf spaces and cortical sulci appear normal there is no abnormal leptomeningeal or parenchymal enhancement brainstem and cerebellum appear normal the normal major intracranial flow voids are patent polyp retention cyst is noted in the left maxillary sinus mucosal thickening is noted in bilateral anterior ethmoid air cells and right posterior ethmoid air cells mucosal thickening is noted in bilaterak inferior mastoid air cells the orbits are unremarkable the marrow of the skull and visualized cervical vertebrae is hypointense on t1 weighted images
Impression:
1 no evidence of acute infarct intracranial hemorrhage or space-occupying lesion 2 no abnormal leptomeningeal or parenchymal enhancement 3 changes of chronic small vessel ischemic disease 4 marrow of the skull and visualized cervical vertebrae is hypointense on t1 weighted images this may represent marrow reconversion due to anemia or due to marrow infiltrative disorders correlation with laboratory values is advised these findings were discussed with dr ___ ___ by dr ___ via telephone at 9 21 am on ___
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Findings:
the brain parenchyma appears normal there is no evidence of acute infarct intracranial hemorrhage or space-occupying lesion brainstem and cerebellum appear normal the ventricles extra-axial csf spaces and cortical sulci appear normal bilateral hippocampi are symmetrical and show no abnormal focal signal abnormality there is no abnormal leptomeningeal or parenchymal enhancement the major intracranial flow voids are maintained mucosal thickening is noted in bilateral ethmoid air cells and bilateral maxillary sinuses a small retention cyst polyp is noted in the left maxillary sinus the visualized mastoid air cells are clear the orbits and osseous structures are unremarkable soft tissue nodules are noted in left high parietal region and right occipital region unchanged since the prior study and likely represent sebaceous cysts
Impression:
1 no evidence of acute infarct intracranial hemorrhage or space-occupying lesion 2 bilateral hippocampi are symmetrical with no focal signal abnormality 3 no abnormal leptomeningeal or parenchymal enhancement
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the cerebral sulci ventricles and extraaxial csf containing spaces are enlarged in keeping with age-related generalized volume loss there is no shift of the midline structures the brain parenchyma has normal ___-white matter differentiation multiple flair and t2 white matter foci are seen in the corona radiata periventricularly as well as in the pons in keeping with chronic small vessel ischemic disease in the left posterior aspect of the thalamus there is a lacunar flair hyperintense lesion with slowed diffusion most likely corresponding to a subacute lacunar infarct the lesion is associated with very mild contrast enhancement that is likely a result of disrupted blood-brain barrier but might also suggest a non-vascular etiology otherwise no abnormal parenchymal or leptomeningeal enhancement is identified there is no evidence of intracranial hemorrhage or space occupying lesion the visualized paranasal sinuses and mastoid air cells are clear the orbits and osseous structures are unremarkable
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1 t2 hypointense focus in the posterior aspect of the left thalamus with slowed diffusion and mild contrast enhancement most likely representing a subacute infarct with regard to enhancement a followup study should be scheduled in four to six weeks to definitely rule out underlying mass such as lymphoma 2 evidence of global cerebral volume loss as well as sequela of chronic small vessel ischemic disease the report was communicated to dr ___ via telephone at 4 pm
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Findings:
cerebral sulci ventricles and extra-axial csf-containing spaces have normal size and configuration there is no shift of the midline structures the brain parenchyma demonstrates maintained ___-white differentiation few scattered flair hyperintense white matter foci are noted and in keeping with chronic small vessel ischemic disease no abnormality is noted with regard to the basal ganglia brainstem cerebellum and craniocervical junction there is no evidence of acute infarction intracranial hemorrhage space-occupying lesion or mass effect there are normal flow voids of the intracranial vessels the visualized paranasal sinuses and mastoid air cells are clear
Impression:
few scattered non-specific foci of t2 flair hyperintensities otherwise no significant abnormalities on mri without gadolinium
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Findings:
on diffusion-weighted images there is a punctate focus of hyperintensity with questionable correlate on adc map within the left insular lobe cortex while an additional hyperintense lesion within the right corona radiata is associated with flair t2 hyperintensity and normal appearance on adc map this focus may represent a further embolic infarct of more subacute chronicity none of these lesions demonstrates enhancement the cerebral sulci ventricles and extra-axial csf-containing spaces have normal size and configuration there is no shift of the midline structures the ___-white matter differentiation is preserved there is no evidence of intra- or extra-axial hemorrhage space-occupying lesion and mass effect flow voids of the major intracranial vessels are preserved there is mucosal thickening involving the left sphenoid sinus as well as bilateral fluid retention within the mastoid air cells
Impression:
1 focus of restricted diffusion in the left insular lobe cortex which in the setting of endocarditis appears highly concerning for embolic stroke 2 an additional focus in the right corona radiata with normal adc map and flair hyperintensity may represent a further focus of more subacute chronicity 3 there is no evidence abscess hemorrhage or space-occupying lesion comment the findings were communicated to dr ___ ___ ___ by dr ___ brodoefel via telephone at 12 30 pm on ___
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Findings:
there is a tiny focus of hyperintensity within the inferior left cerebellar hemisphere which is atypical in appearance for hemorrhage and likely represents artifact however attention in this area on subsequent examinations is recommended there is no mass effect or shift of the normally midline structures the ventricles and sulci are prominent but symmetric compatible with involutional change old right caudate lacune is again identified there are extensive patchy areas of low attenuation within the periventricular and subcortical white matter compatible with chronic microvascular ischemic changes the ___-white matter differentiation is grossly preserved there is no evidence of an acute major vascular territorial infarction the visualized osseous structures are unremarkable the paranasal sinuses are notable for fluid and mucosal thickening within the ethmoid air cells and sphenoid sinus
Impression:
1 tiny focus of hyperdensity within the inferior left cerebellar hemisphere which is most likely artifactual however a small hemorrhagic focus cannot be definitively excluded 2 no evidence of an acute major vascular territorial infarction on the basis of this study 3 tissue loss in the right frontal lobe most probably chornic infract 4 if acute infarct is a high clinical suspicion and mri with dwi is the ideal study
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Findings:
there is no acute intracranial hemorrhage shift of normally midline structures hydrocephalus or major vascular territorial infarction there is prominence of the sulci slightly greater than expected for stated age of the patient multiple lacunar infarcts are present similar in appearance compared to the previous examination these lacunar infarcts occur primarily within the basal ganglia the internal-external capsule as well as corona radiata and pons and overall they are more prominent on the left side periventricular white matter changes are consistent with underlying small vessel ischemia the density values of the brain parenchyma are otherwise maintained the osseous structures soft tissues visualized portions of the paranasal sinuses and mastoid air cells are otherwise unremarkable
Impression:
no evidence of acute intracranial pathology multiple lacunar infarcts as described above
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"the study is compared with the most recent cect of ___ as well as previous examination of ___ and a series of studies dating to ___ the study is somewhat limited by persistent patient motion artifact as above as well as the extensive post-surgical changes status post extensive right frontotemporoparietal craniectomy and partial temporal lobectomy this includes residual hemorrhage particularly in the inferior-anterior aspect of the middle cranial fossa with substantial associated ""blooming"" magnetic susceptibility artifact limiting the utility of the dwi sequence in this region re-demonstrated is the predominantly ""simple""-appearing collection in the craniectomy bed within the subgaleal scalp this demonstrates only thin and discontinuous rim enhancement and no evidence of slow diffusion the extensive right parafalcine subdural fluid collection demonstrates predominantly similar signal characteristics however though this process too demonstrates only thin and incomplete rim-enhancement its most dependent portion demonstrates layering ""sediment"" with uniformly slow diffusion 606 602 ___ not accounted for by susceptibility artifact series 9 though this may be attributable to layering proteinaceous or other complex macromolecular material pyogenic infection is also a consideration apart from the extensive residual blood products in the anteromedial aspect of the middle cranial fossa and the lateral aspect of the right frontal pole there is no definitive evidence of slow diffusion elsewhere other than expected post-surgical pachymeningeal enhancement there is no pathologic leptomeningeal or parenchymal focus of enhancement elsewhere the principal intracranial vascular flow-voids including those of the dural venous sinuses are preserved and these structures enhance normally noted is extensive fluid layering within the right sphenoid air cell and its pterygoid recess as well as virtual-complete fluid-opacification of the mastoid air cells bilaterally unchanged from the recent ct studies"
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"study somewhat limited by difficulties with patient positioning and motion as well as the extensive post-surgical changes with abundant residual blood products 1 the right-sided extra-axial and scalp fluid collections demonstrate ""simple"" fluid with only thin and discontinuous rim enhancement more suggestive of post-surgical seromas however there is material demonstrating slow diffusion apparently sedimenting within the dependent posterior component of the right parafalcine subdural collection and purulent material related to pyogenic superinfection is a consideration again no organized abscess is identified at this site 2 extensive fluid-opacification of the mastoid air cells with layering fluid within the right sphenoid air cell while this finding is commonly seen in intubated patients with protracted supine positioning it should be correlated clinically"
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Findings:
the study is significantly limited due to patient motion-related artifacts despite sedation patient is status post left-sided craniotomy with post-surgical changes there is a fluid collection in the left-sided scalp soft tissues along with hematoma in the anterior part of the frontal soft tissues better seen on the subsequent ct study there are areas of decreased diffusion noted in the left mca territory but extensive and involving the left frontal and the parietal lobes as well as the basal ganglia and the left corticospinal tract in the internal capsule extending into the left cerebral peduncle some of the areas of increased t2 signal relate to t2 shine-through artifact there is also a left-sided parafalcine subdural fluid collection hemorrhage extending on to the left side of the tentorium and also along the left middle cranial fossa which is new from the prior study with a maximum transverse dimension of 6mm the etiology of this finding is uncertain there is mild rightward shift of the midline structures there is mild indentation on the left lateral ventricle on the post-contrast images there is diffuse gyriform enhancement of the cortex in the left mca territory as well as parts of the left basal ganglia likely related to the subacute stage of the infarct along with associated swelling of the parenchyma however some of the areas are pre-contrast t1 hyperintense likely related to blood products for example in the left parietal lobe subcortical and cortical locations series 8 image 19 17 and in the basal ganglia series 8 image 15 associated inflammation infection in the parenchyma and fluid collections cannot be completely excluded and needs clinical correlation
Impression:
1 extensive acute subacute left mca territory infarct as described above with diffuse gyriform enhancement of the cortex in the left mca territory as well as parts of the left basal ganglia likely related to the subacute stage diffuse enhancement may relate to suggest subacute stage however consider close followup to assess for any inflammatory infectious component given the lack of prior post-contrast sequences for comparison mild rightward shift of the midline structures and mild indentation on the left lateral ventricle from the mass effect attention on close followup 2 left parafalcine subdural fluid collection extending along the left side of the tentorium as well as in the left middle cranial fossa part of this may relate to subacute blood products 3 fluid collections in the left frontal parietal and temporal soft tissues along with blood products assessment for superimposed inflammation infection is limited on the present study consider close followup to assess stability 4 diffuse increased signal in the left mastoid air cells from fluid mucosal thickening other details as above study limited due to patient motion-related artifacts assessment for vascular abnormalities is limited on the present study
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Findings:
post-surgical changes are again identified within the right middle cranial fossa there is also a small extra-axial collection overlying the left temporal and frontal lobes which appears to be subdural hemorrhage which has undergone degradation and is unchanged in size when compared to the previous study the hemorrhage within the right middle cranial fossa is no longer identified the small right putamen infarct is again identified the tense subgaleal fluid collection appears larger when compared to the previous study there are areas of higher density within this collection which may represent clot the right craniotomy is again identified as well as surgical staples over the right scalp
Impression:
post-operative changes within the right middle cranial fossa essentially unchanged right putamen infarct increase in size of tense subgaleal collection infection of the collections cannot be excluded
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Findings:
the study is compared with the most recent enhanced mr examination of ___ as well as previous study of ___ and the interval nect of ___ as before the patient is status post suboccipital craniectomy with resection of the large metastasis in the inferior to mid-right cerebellar hemisphere there has been continued further resolution of post-surgical changes in the region there is residual flair- hyperintensity with relatively thin marginal enhancement surrounding the surgical bed as well as expected overlying uniform pachymeningeal enhancement in addition there is a persistent small fluid collection in the craniectomy bed now measuring up to 4 7 cm trv allowing for expected susceptibility artifact at the operative site there is no focus of slow diffusion to suggest an acute ischemic event and the principal intracranial vascular flow voids including those of the dural venous sinuses are preserved and these structures enhance normally there is no evidence of intra- or extra-axial hemorrhage elsewhere there is no pathologic parenchymal leptomeningeal or dural focus of enhancement elsewhere to suggest additional metastasis the sella parasellar region and remainder of the skull base and orbits are unremarkable the limited included upper cervical vertebral clival and calvarial bone marrow signal is maintained with no suspicious osseous lesion though there are scattered prominent lymph nodes in the posterior cervical triangles bilaterally these are essentially unchanged since the initial study of ___ and do not meet imaging size criteria for pathologic enlargement
Impression:
1 status post suboccipital craniectomy with resection of right cerebellar hemispheric metastatis with continued interval improvement in post-surgical changes 2 allowing for small amount of residual blood products there is persistent relatively thin marginal enhancement at the resection bed with expected overlying pachymeningeal enhancement however allowing for this there is no discrete nodular or mass-like enhancement to suggest residual metastatic disease 3 no new focus of metastatic disease identified
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Findings:
as seen on ___ there has been a frontal craniotomy the postoperative intracranial air is no longer seen at the site of the mass seen on ___ there are blood breakdown products previously consisting of deoxyhemoglobin on the current study there is t1 hyperintense methemoglobin there is more peripheral enhancement of the surgical site hemorrhage than on the study from six days previously as expected superior and posterior to the surgical site there are areas of restricted diffusion probably subacute infarcts which extend posteriorly to involve a small portion of the precentral gyrus without extension compared to the earlier study there is a small right-sided nearly csf intensity subdural collection unchanged in size from ___ the right sulci remain patent the ventricles are normal in size the right lateral ventricle is slightly smaller than the left without change there remains an area of susceptibility effect in the posterior inferior right temporal lobe perhaps related to old trauma the brain stem and cerebellum are unremarkable
Impression:
1 there has been the expected evolution of the blood breakdown products at the medial frontal surgical site as expected there is more peripheral enhancement 2 there is no change in the slight mass effect 3 there is a posterior left frontal infarct without change in extent compared to ___ 4 the nearly csf intensity right-sided subdural collection and the hemosiderin in the right temporal lobe are again noted
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the residual left parietal occipital mass measures 3 5 x 3 4 x 6 9 cm today si x ml x ap this shows moderate rim enhancement with subependymal enhancement extending anteriorly into the body of the left lateral ventricle the rim of susceptibility with foci of susceptibility within the residual mass and size are similar to the ___ mri enhancement along the subependymal region of the temporal ___ of the left lateral ventricle is better seen today the temporal ___ of the left lateral ventricle remains enlarged also similar to prior is markedly slow diffusion within the mass adjacent postoperative changes from parietal craniotomy are again demonstrated adjacent flair abnormality is unchanged abnormal increased flair signal within the anterior frontal lobes bilaterally is again demonstrated with interval increase in flair abnormality within the white matter but decreased flair abnormality within the cortex the abnormal flair hyperintensity within the adjacent csf has decreased gyriform enhancement is slightly increased compared to ___ regions of increased signal on the dwi sequence in this region show no definite low signal on adc the diffusion abnormality is not as severe in this region when compared to prior no other new foci of metastases are seen paranasal sinus disease is again demonstrated
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1 rim-enhancing mass in the left parietal occipital lobes with central restricted diffusion similar to prior the restricted diffusion within this mass is similar to the postoperative and preoperative examinations likely representing blood products and residual tumor superinfection of this cavity remains a possiblity thought the unchanged adjacent flair signal makes this less likely 2 interval expected evolution of the bifrontal inflammatory destructive process compatible with the patient's known meningoencephalitis
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Findings:
status post left parietal craniotomy and mass resection with post-surgical changes similar in appearance compared with prior encephalomalacia and ex vacuo dilatation of the occipital ___ of the left lateral ventricle is stable high intrinsic t1 signal intensity surrounding the resection margin is similar in appearance likely representing mineralization or residual blood products superior to the resection margin there is a 12 mm x 19 mm left parietal lesion which demonstrates peripheral intrinsic t1 hyperintensity and rim enhancement with a similar degree of flair abnormality there is diffusion restriction of the enhancing margin as well as of the surrounding white matter a second higher enhancing focus 10 21 also demonstrates a similar degree of surrounding t2 flair signal and restricted diffusion subependymoma restriction diffusion within the medial left occipital lobe is similar in appearance also with surrounding flair abnormality this focus does not demonstrate abnormal enhancement the cerebellum brainstem and visualized cervical cord appear normal dilatation of the ventricles and sulci is likely the result of treatment-related volume loss opacification of the left maxillary sinus and mucosal thickening of the right maxillary sinus is stable the left ethmoid air cells are opacified the mastoid air cells are clear
Impression:
1 stable left parietal and occipital masses with surrounding flair signal abnormality which demonstrate intrinsic enhancement and diffusion restriction recommend continued interim followup 2 left maxillary and ethmoid opacification unchanged compared with prior correlate with symptoms of sinusitis
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Findings:
interval left frontal parietal craniotomy the left parietal lobe rim-enhancing lesion is slightly smaller compared with the prior exam on the current exam the lesion measures 1 2 x 1 3 cm previously measuring 1 2 x 1 7 cm the centrally nonenhancing portion of the lesion is significantly smaller consistent with known recent evacuation the surrounding white matter edema appears grossly decreased compared with the prior exam although no flair sequence was performed on ___ as it was performed as a brain lab protocol the flair signal abnormality compared with the outside hospital mri obtained ___ is significantly diminished on the current study mass effect from the lesion is also slightly diminished compared with the most recent prior exam the smaller left parietal lesion series 100 image 68 has also decreased in conspicuity previously measuring 6 mm currently measuring approximately 4 mm in similar dimension no new enhancing lesions are identified the foci of paranchymal susceptability artifact of the two previously described lesions and scattered right frontal foci are unchanged compared with the mri performed ___ the ventricles and sulci are not enlarged and are unchanged in size the major intracranial flow voids are patent there is minimal mucosal thickening within the left sphenoid sinus the remaining paranasal sinuses and mastoid air cells are clear
Impression:
status post left frontal craniotomy and evacuation of left parietal lesion the two previously described enhancing lesions within the left parietal lobe are decreased in size compared with the prior mri examination of ___ no new lesions identified pl see details above
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Findings:
bilateral parietal craniotomies are identified in the right parietal region edema is identified extending to the frontal region and occipital region with an irregular enhancement the degree of edema and the enhancement have remained unchanged however in the left parietal region compared to the prior study flair signal abnormalities have slightly increased in addition patchy areas of increased signal seen on the flair images in the white matter of the left cerebral hemisphere which are new since the previous mri examination ___ the previously noted enhancement at the left parietal cortex best seen on the mri of ___ has decreased and subtle enhancement is now seen in this region which is unchanged from the recent mri of ___ there is mild prominence of ventricles and sulci unchanged from the prior study there is no midline shift or hydrocephalus no definite other areas of abnormal enhancement seen
Impression:
overall the appearance of edema and enhancement in the right parietal lobe and the edema extending to the right frontal lobe and temporal occipital lobes is unchanged since compared to the mri of ___ however there are now several faint new signal abnormalities seen in the left cerebral hemisphere in the left parietal region and deep white matter the appearance of this white matter abnormalities is less typical for a vasogenic edema in absence of associated enhancement in the areas and could be related to therapy enhancement seen in the left parietal region in the subcortical area on the mri of ___ has decreased no definite new areas of enhancement seen
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Findings:
there is a focus of hyperintensity seen on flair images in the left parietal lobe with rim-enhancing lesion in this area measuring approximately 3 1 x 2 1 cm there are also signal changes within the left frontoparietal sulci and in the left frontoparietal subdural space with extensive enhancement indicative of leptomeningeal and pachymeningeal enhancement there are no other foci of signal abnormality or abnormal enhancement seen small areas of low signal are seen at the margin of the enhancing rim of the lesion on susceptibility images indicative of blood products there is mild mass effect in the left lateral ventricle without midline shift there is no hydrocephalus the rim-enhancing lesion demonstrate high signal on diffusion images with particular low signal on adc map seen at the wall of the lesion and also extending to the left subdural space in the frontoparietal region
Impression:
rim-enhancing left parietal lesion with surrounding edema with enhancement of the adjacent leptomeninges and pachymeninges with subdural collection in the left frontoparietal region measuring approximately 5 mm both the rim of the lesion as well as the subdural collection demonstrate restricted diffusion this finding is suspicious for an abscess with a question of subdural empyema alternatively the lesion could be a metastatic lesion with blood products in the subdural space giving restricted diffusion although the appearances are less favorable for metastatic lesion no midline shift is seen mild mass effect on the left lateral ventricle the findings were discussed with the neurosurgery ___ time of interpretation of this study on ___ at 11 30 a m
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diffusion images demonstrate no evidence of slow diffusion to indicate acute infarct there is severe dilatation of the lateral and third ventricles with a normal fourth ventricle the aqueducts appeared small in its lower portion there is hyperintense foci in the periventricular white matter there is no midline shift seen following gadolinium no abnormal parenchymal vascular or meningeal enhancement identified note is made of increased signal seen along the sulci in both occipital lobes on flair images this could be secondary to increased protein within the csf or could be artifactual
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severe hydrocephalus with small aqueduct indicative of aqueduct stenosis periventricular white matter hyperintensities could be indicative of small vessel disease no midline shift increased signal along the sulci in occipital lobe could be artifactual or due to increased protein in the csf no evidence of abnormal enhancement
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Findings:
the diffusion images demonstrate no evidence of restricted diffusion to indicate acute infarct there is no midline shift mass effect or hydrocephalus there is prominence of ventricles and sulci indicating brain atrophy mild periventricular white matter changes due to small vessel disease are seen post-gadolinium images are limited by motion as described above no obvious large area of enhancement is seen however
Impression:
no acute infarct brain atrophy limited post-gadolinium images due to motion no distinct large area of enhancement seen however better evaluation can be obtained with proper sedation and a repeat post-gadolinium study if clinically indicated
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Findings:
the diffusion-weighted images demonstrate no evidence of an area of restricted diffusion to indicate acute infarct again identified is a chronic infarct in the right occipital region with ex vacuo dilatation of the right temporal ___ and occipital ___ multiple periventricular hyperintensities due to small vessel disease are seen in the left frontoparietal region there is an area of white matter edema extending to the subcortical u-fibers without involvement of the cortex following gadolinium administration diffuse enhancement is seen in this region no evidence of restricted diffusion is seen in this region on the diffusion-weighted images this area exerts slight mass effect on the left lateral ventricle no evidence of acute or chronic hemorrhage is seen on susceptibility or flair images
Impression:
left frontoparietal area of white matter edema with enhancement does not have the characteristic appearance of an infarct and is suspicious for a neoplastic lesion although a subacute infarct could also demonstrate enhancement the lack of involvement of the cortex is against ischemic pathology the differential diagnostic considerations include glioma or lymphoma the findings were conveyed to dr ___ ___ at the time of interpretation of this study on ___ at 6 00pm
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Findings:
the diffusion images demonstrate no evidence of slow diffusion to indicate acute infarct there is moderate prominence of sulci indicating brain atrophy there is no midline shift or hydrocephalus mild periventricular changes of small vessel disease are seen following gadolinium no evidence of abnormal parenchymal vascular or meningeal enhancement identified
Impression:
moderate brain atrophy no enhancing brain lesions to indicate metastatic disease
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Findings:
on diffusion weighted images no evidence of restricted diffusion is seen to indicate acute infarct there is no evidence of midline shift mass effect or hydrocephalus the ventricles and extraaxial spaces are normal in size there are no focal signal abnormalities seen following gadolinium no evidence abnormal parenchymal vascular or meningeal enhancement seen
Impression:
normal mri of the brain with and without gadolinium no evidence of acute infarct mass effect or enhancing lesion
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a shunt has been placed into the frontal ___ of the right lateral ventricle the temporal horns of the lateral ventricles are less dilated compared to the head ct of three hours prior overall the lateral ventricles third ventricle and cerebral aqueduct remain prominent and there is transependymal edema the fourth ventricle remains compressed there is marked diffuse cerebellar edema and there area areas of increased t2 signal in the pons there are no foci of slow diffusion in the cerebellum or brainstem however there is a small focus of slow diffusion in the left parietal subcortical white matter there is a corresponding hyperintense lesion on t2w images suggesting an evolving acute infarction there is diffuse high t2 signal in the white matter of the occipital lobes this appearance is concerning for hypertensive encephalopathy there is elevated t2 signal in the right frontal sulci adjacent to the intraventricular drain and likely blood secondary to drain placement mra of the circle of ___ was performed with a 3d time of flight method mip and source images are reviewed
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1 diffuse edema in the cerebellar and occipital white matter concerning for hypertensive encephalopathy clinical correlation recommended 2 small acute infarction in the left parietal subcortical white matter no evidence of acute infarction in the cerebellum 3 slight decrease in dilatation of the lateral ventricles persistent occlusion of the fourth ventricle 4 follow-up mri with diffusion-weighted images in a few days would be helpful for further evaluation of the above abnormalities 5 mra of the circle of ___ demonstrates flow in the major proximal branches of the intracranial circulation except for the left vertebral artery
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Findings:
there is subacute hemorrhage identified within the basal cisterns in lateral ventricles as well as within the right frontal ___ in the region of an intraventricular shunt the shunt appears to terminate within the right lateral ventricle there are small foci of increased t2 density within the right cerebellum which do not demonstrated restricted diffusion on the diffusion weighted imaging and are therefore more consistent with remote infarct there are large areas of restricted diffusion involving the right occipital ___ temporal ___ and posterior parietal ___ primarily though not exclusively within the right middle cerebral artery distribution as noted on the patient's ct scan there has been a decrease in size of the ventricles consistent with diffuse cerebral edema the mra of the circle of ___ and its tributaries is significantly limited secondary to shine through artifact generated by the subarachnoid hemorhage there are secretions within the paranasal sinuses a not unexpected finding in this intubated patient
Impression:
restricted diffusion within the right occipital temporal and posterior parietal lobes consistent with acute infarct diffuse cerebral edema with subacute subarachnoid hemorrhage
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Findings:
there are no previous studies available for comparison there are no signal abnormalities identified on the diffusion weighted images therefore there is no evidence of recent infarction there is no susceptibility artifact within the brain to indicate blood products on t2 weighted images there is cortical signal abnormality extending through the right posterior superior frontal lobe cortex and right anterior parietal lobe cortex the gyri in this location are not expanded increased t2 signal in the subcortical white matter and in small foci throughout the cerebral white matter of both hemispheres the ventricles are normal in size and configuration deep grey structures appear normal the brain stem and cerebellum has a normal appearance flow voids are seen in the major branches of the circle of ___ there is limited visualization of some structures due to motion artifact on images mr angiography is limited due to motion artifact there is flow signal seen in both intracranial internal carotid arteries and in the intracranial vertebral arteries and basilar artery there is flow signal in the proximal portions of the anterior middle and posterior cerebral arteries
Impression:
there is a right frontoparietal cortical infarction which is not acute but of uncertain duration no acute fracture is evident mra of the circle of ___ demonstrates flow in the major intracranial branches of the circle of ___ findings were reported to dr ___ in the eu at 1 45 pm on ___
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Findings:
there is an artifact over a portion of the right temporal lobe due to the presence of metallic surgical skin clips as reported by the clinical staff this also limits the diffusion weighted images however there is no clear evidence of restricted diffusion in the left hemisphere or right occipital area where signal can be appreciated on t2 weighted and flair images there are no clear signs of cortical hyperintensity or gyral edema to indicate acute cortical infarction there are extensive areas of increased t2 signal in the periventricular and subcortical white matter which reflect chronic microvascular ischemia and infarction there are post-surgical changes in the left cerebellum which are stable the ventricles are normal in size and configuration there are no abnormal extra-axial collections mr angiographic images demonstrate flow in both intracranial vertebral arteries the basilar artery the proximal portions of the superior cerebellar and the posterior cerebral arteries there is also flow signal in both intracranial internal carotid arteries and in the anterior and middle cerebral arteries including the sylvian branches bilaterally
Impression:
mri of the brain demonstrates chronic changes but no clear evidence of an acute infarction or intracranial mass effect examination is slightly limited by metal artifact mra of the circle of ___ demonstrates flow in the major branches of the circulation findings were discussed with the medicine team caring for the patient at ___
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Findings:
this exam was terminated early due to patient agitation there are no t2 sequences available for evaluation on the t1-weighted sequences there are bilateral small extra-axial fluid collections measuring up to 6 mm in diameter which likely represent subdural hematomas or hygromas the ___- white matter differentiation is normal and the ventricles are normal in size on the diffusion-weighted images there is increased signal on the adc maps within the bilateral occipital parietal lobes corresponding to the areas of hypodensity seen on ct which may represent t2 shine-through and vasogenic edema again supporting the suspicion of pres there is also an area with adc bright signal within the right cerebellar hemisphere corresponding to an area of prior infarct no evidence of acute infarction on the diffusion-weighted images
Impression:
1 very limited study with no t2-weighted images and motion-limited mrv high signal intensity within the occipital and parietal lobes bilaterally on the adc map suggests t2 shine-through vasogenic edema and would be consistent with a diagnosis of pres posterior reversible encephalopathy syndrome no gross venous sinus thrombosis is identified though again this is limited by motion 2 old infarct within the right cerebellar hemisphere 3 bilateral subdural collections over the cerebral convexities
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again identified are postsurgical changes consistent with right hemicraniotomy and cranioplasty there is marked leftward shift of normally midline structures of approximately 1 3 cm of midline shift this is not significantly changed when compared to prior exam there is no evidence of acute hemorrhage or infarct there are no mass lesions or areas of edema identified enhancement along the postsurgical site is identified otherwise there is no abnormal enhancement identified
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1 persistent leftward shift of normally midline structures by approximately 1 3 cm 2 no evidence of acute infarct or new hemorrhage findings were discussed with dr ___ ___ by telephone at 1 30 p m
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Findings:
there are post-operative changes identified with craniotomy in the left frontoparietal region there are clips and artifacts from embolization identified near the left skull base and left parietal region there is no mass effect midline shift or hydrocephalus no hemorrhage identified no areas of brain edema are seen
Impression:
since the previous study the abnormal dilated venous structures are no longer visible secondary to embolization no evidence of abnormally dilated or venous structures are seen to indicate persistent arteriovenous fistula other findings as described above
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Findings:
there has been no change since the prior examination there is no evidence of a new intracranial hemorrhage there is low attenuation throughout the white matter of the right cerebral hemisphere as on the prior examination this is consistent with encephalomalacia in the region of the patient's prior large intraparenchymal hemorrhage there is no shift of the normally midline structures the lateral ventricles are dilated to a similar degree as on the prior examination the low attenuation focus adjacent to the frontal ___ of the left lateral ventricle is unchanged the patient has had a prior right parietal craniotomy
Impression:
no change from the prior examination of ___ with no evidence of a new intracranial hemorrhage extensive encephalomalacia within the right cerebral hemisphere from prior intraparenchymal hemorrhage
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Findings:
again seen is a large area of vasogenic edema corresponding to an evolving right mca infarct there has been interval slight increase in leftward shift of normally midline structures 2 14 up to 9 mm in comparison to 6 mm on the ___ examination post-right frontotemporal craniotomy changes are redemonstrated moderate dilation of the ventricles appears stable no new hemorrhage is detected
Impression:
evolving right mca infarct with right frontotemporal post-surgical changes there has been slight increase in midline shift however the ventricles remain unchanged in size
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Findings:
patient is status post right occipital craniotomy with post-surgical changes noted there is no evidence of abnormal enhancement in the surgical bed or elsewhere to suggest recurrence or new lesion the ventricles and extra-axial csf spaces are normal there is no evidence of acute hemorrhage shift of normally midline structures mass or infarction
Impression:
post-surgical changes in the right occipital region no evidence of recurrence
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again seen in the medulla of the spinal cord is a 8-mm lesion demonstrating low-signal intensity on t1-weighted images there is no definite enhancement again noted is minimal expansion of the right medulla at this level no other intraaxial lesions are identified the brain parenchyma is unchanged in appearance the ventricles and sulci are normal in size the surrounding osseous and soft tissue structures are unremarkable
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8 mm lesion in the medulla is without significant enhancement given this finding and the findings on the mri head from earlier today and the subsequent cervical spine mr diagnostic considerations include a cavernoma that has bled although a metastatic lesion cannot be entirely excluded
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Findings:
the brain parenchyma is grossly normal there is no evidence of a mass or abnormal enhancement no t2 hyperintensity is seen in the periaqueductal region the signal intensity of the mammillary bodies is difficult to evaluate on the t2- weighted images due to volume averaging effects no enhancement of them is identified the cerebral sulci are minimally prominent the ventricles are normal in size there is a tornwaldt cyst just to the right of midline also visible on the ct of ___
Impression:
the brain parenchyma appears normal there is some limitation by patient motion
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Findings:
the brain parenchyma appears normal no area of restricted diffusion is seen to suggest a recent infarct on these 5-mm-thick images the internal auditory canals appear normal as seen on the ct there is hyperostosis frontalis there is no evidence of a right-sided subdural collection artifact was noted related to the calvarium on the ct the ventricles and sulci are normal in size there is slight enhancement of the tentorium seen on the coronal images a nonspecific finding it is quite common after a lumbar puncture no leptomeningeal enhancement is seen
Impression:
1 the brain parenchyma appears normal 2 there is minimal tentorial enhancement 3 there is no evidence of a right-sided subdural collection
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Findings:
there are again seen numerous areas of high attenuation lesions throughout the brain parenchyma corresponding to the hemorrhagic lesion seen on the recent mr the lesions do not appear to be significantly changed in size or number there are no new areas of intraparenchymal or extra-axial hemorrhage there is no shift of normally midline structures or mass effect the ventricles cisterns and sulci are unremarkable the surrounding osseous and visualized paranasal sinuses are unremarkable
Impression:
stable appearance of multiple high attenuation lesions felt to be secondary to toxoplasmosis
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Findings:
the brain parenchyma appears normal there is no evidence of acute infarct intracranial hemorrhage or space-occupying lesion ventricles and extra-axial csf spaces appear normal subtle flair hyperintense signal is noted along the right frontal and parietal sulci series 4 image 16 with mild post contrast enhancement along the sulci in these regions there is no abnormal parenchymal enhancement brainstem and cerebellum appear normal the orbits are unremarkable there is opacification of the right anterior ethmoid air cells rest of the visualized paranasal sinuses and mastoid air cells are clear hyperintense signal is noted on t2-weighted images in the upper cervical spinal cord extending up to the cervicomedullary junction it appears hypointense on t1-weighted images this could be suggestive of extension of the transverse myelitis or venous edema ischemia secondary to meningitis
Impression:
1 no evidence of acute infarct intracranial hemorrhage or space-occupying lesion 2 subtle flair hyperintense signal along the right frontal and parietal sulci series 4 image 16 with mild post contrast enhancement along the sulci in these regions 3 hyperintense signal noted on t2-weighted images in the visualized part of the cervical spinal cord extending to cervicomedullary junction which has increased since the prior study and is suggestive of extension of either transverse myelitis or venous ischemia edema secondary to meningitis these findings were communicated to dr ___ ___ by dr ___ via telephone at 11 35 a m on ___
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patient is status post right craniotomy and frontal lobe resection compared to the previous examination there is now less mass effect resulting from the resection cavity on the right frontal lobe hemorrhagic material still persists along the margins of the resection cavity 3 17 and on post-contrast imaging there remains enhancement along the margin of the resection cavity 10 17 edema surrounding the resection cavity has decreased since the prior examination there has been interval increased size and development of multiple metastatic lesions enlarged lesions are present at the right vertex 7 103 the left vertex along the midline 7 103 and an enhancing nodule along the margin of the left lateral ventricle 7 82 now measuring 1 cm a new enhancing nodule is present in the left occipital lobe 7 78 and also in the left occipital lobe 7 57 no intracranial hemorrhage is present apart from blood products in the surgical resection cavity the size and configuration of the ventricles appears normal there is no abnormal restricted diffusion vascular flow voids appear normal a small amount of extra-axial fluid is seen in the bifrontal region which may be small hygromas post-surgery pneumocephalus has resolved the globes orbits and sinuses appear normal
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1 interval decreased compression upon the right lateral ventricle due to decreased mass effect from a right frontal surgical resection and decreased peri-lesional edema however there remains some enhancement along the margin of the resection cavity concerning for residual tumor although a component of this could be postoperative 2 multiple new or enlarged metastatic nodules throughout the right and left hemispheres as some of the lesions may be leptomeningeal evaluation of csf fluid to check for leptomeningeal disease may be warranted
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Findings:
postoperative changes of left frontal craniotomy and left frontal lobe resection cavity are again noted there is stable dural thickening fluid along the extra-axial space overlying the left frontal lobe the nodular peripheral enhancement noted on the prior study surrounding the left frontal surgical cavity has diminished in conspicuity although remains predominantly at the posterior inferior margin of the resection cavity the surrounding flair-hyperintensity of the left frontal lobe has not significantly changed also the small rim-enhancing lesion at the inferior aspect of the resection cavity is less conspicuous similar to the decrease in rim enhancement of the surgical cavity no new lesions are identified the ventricles and sulci are not enlarged there is minimal ex vacuo dilatation of the left lateral ventricle adjacent to the surgical cavity there is no evidence of restricted diffusion intracranial hemorrhage or significant mass effect or shift of midline structures the major intracranial flow voids are present the paranasal sinuses and mastoid air cells are clear
Impression:
the left frontal resection cavity demonstrates diminished conspicuity of the nodular peripheral enhancement with persistent nodular enhancement predominantly at the inferior posterior margin of the cavity although the decrease in enhancement of the periphery of the cavity is suggestive of resolving postoperative enhancement continued close interval followup is recommended as residual tumor cannot be excluded
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Findings:
post-operative changes are noted status post left temporal craniotomy with resection cavity in the left temporal lobe unchanged in size since the previous study there is no associated enhancement surrounding the resection cavity there is mild dural enhancement noted overlying the resection cavity also unchanged and an expected post-operative appearance t2- and ___-hyperintensity in the periventricular white matter of left frontal parietal and temporal lobes is also unchanged since the prior study there is no evidence of new enhancing lesion there is no evidence of acute infarct intracranial hemorrhage or shift of midline structures the major intracranial flow voids are preserved the ventricles are stable in size partially empty sella turcica variant anatomy is again noted in the right orbit there is a t2-hyperintense structure medial to the globe unchanged since the prior study which may represent dacryocystocele the orbits are otherwise unremarkable the visualized paranasal sinuses and mastoid air cells are clear
Impression:
1 post-operative changes status post left temporal craniotomy with resection cavity in the left temporal lobe unchanged without enhancement 2 stable ___-hyperintensity in the left frontoparietotemporal lobe which likely represents treatment-related changes 3 no new enhancing focus 4 stable cystic structure in the right orbit medial to the globe which likely represents dacryocystocele
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Findings:
in the right parietal lobe there has been interval resection of the previously seen enhancing tumor in the resection bed there is peripheral t1 hyperintensity and susceptibility artifact consistent with blood products on the post-contrast t1-weighted images there are no definite foci of residual enhancement there is restricted diffusion at the superior margin of the resection bed which could be related to perioperative ischemia or post-surgical changes bilateral prefrontal pneumocephalus is present areas of restricted diffusion seen in the bilateral frontal lobes and along the medial occipital lobe likely relate to artifact from postoperative pneumocephalus expected craniotomy changes are noted in the right parietal bone and overlying soft tissues there is no evidence of a large extra-axial fluid collection or hemorrhage other than in the post-surgical resection bed the brain is unremarkable there is no evidence of a second enhancing lesion there are no areas of new edema on flair images the ventricles and sulci are normal in size and configuration the basal cisterns are patent the orbit and periorbital spaces are normal the sinuses are well aerated
Impression:
1 no evidence of residual enhancement surrounding the resection bed recommend continued follow up after resoluation of the immediate post-surgical changes 2 expected postoperative changes with a small amount of blood products pneumocephalus and adjacent restricted diffusion
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Findings:
there has been an interval increase of the enhancing nodular component in the left parietal lobe lesion surrounding the post-surgical cavity the cavity now measures 34 x 25 mm including the enhancing thick-walled rim from previously 19 x 16 mm the adjacent satellite 6-mm enhancing nodule superomedial to the resection site is also increased from the prior exam currently measuring 6 mm from previously 4 mm there is also a significant increase of the edema surrounding the postsurgical cavity which causes mass effect on the left parietal and frontal lobes with effacement of the sulci there is mass effect on the frontal and occipital horns of the left lateral ventricle and minimal shift of normally midline structures to the right by about 4 mm new compared to the prior exam there is restricted diffusion within the post-surgical cavity similar compared to ___ and difficult to interpret due to the residual postsurgical blood products in the cavity the recently treated 7 x 5 mm right temporal lobe enhancing lesion series 10 image 37 is not significantly changed from the prior exam the previously seen right parietal lesion measures 4 mm is unchanged the intracranial arterial flow voids are noted the paranasal sinuses mastoids and imaged orbits are unremarkable except for minimal mucosal thickening in the left maxillary sinus there are no suspicious bony or soft tissue lesions
Impression:
1 significant interval increase of the left parietal lobe leison - now has thick-walled nodular enhancing component surrounding the left parietal post-surgical cavity 2 signifiant interval increase of the cavity surrounding edema with increased associated mass effect 3 above findings can relate to radiation necrosis versus tumor progression correlate clinically for infection given the recent procedure follow up closely if no intervention is contemplated 4 unchanged right temporal and right parietal enhancing foci d w dr ___ by dr ___ on ___ at 4 30pm
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there is no evidence of acute infarct seen on diffusion images there is no evidence of midline shift mass effect or hydrocephalus the ventricles and extra-axial spaces are normal in size without midline shift mass effect or hydrocephalus there are no territorial infarcts except for subtle periventricular hyperintensities of non-specific nature no other foci of signal abnormalities are seen following gadolinium no evidence of abnormal parenchymal vascular or meningeal enhancement seen
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no evidence of acute infarct or enhancing brain lesions no other significant abnormalities on mri of the brain with and without gadolinium
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Findings:
the diffusion images demonstrate no evidence of acute infarct the ventricles and extraaxial spaces are normal in size there is no evidence of midline shift mass effect or hydrocephalus seen following gadolinium no evidence of abnormal parenchymal vascular or meningeal enhancement seen
Impression:
no significant abnormalities detected on the mri of the brain with and without gadolinium
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Findings:
on diffusion weighted images no evidence of restricted diffusion is seen to indicate acute infarct there is no evidence of midline shift mass effect or hydrocephalus the ventricles and extraaxial spaces are normal in size there are no focal signal abnormalities seen following gadolinium no evidence abnormal parenchymal vascular or meningeal enhancement seen
Impression:
normal mri of the brain with and without gadolinium no evidence of acute infarct mass effect or enhancing lesion
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Findings:
there is no evidence of acute infarct seen on diffusion images there is no evidence of mass effect midline shift or hydrocephalus identified no obvious focal abnormalities are seen on the motion limited axial flair images following gadolinium no evidence of abnormal parenchymal vascular or meningeal enhancement is seen
Impression:
no evidence of acute infarct or abnormal enhancement slightly limited by motion
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Findings:
the ventricles and extra-axial spaces are within normal limits no evidence of mid-line shift mass effect or hydrocephalus is seen there are no focal signal abnormalities identified no evidence of territorial infarct seen no evidence of restricted diffusion noted on the diffusion weighted images following gadolinium no evidence of abnormal parenchymal vascular or meningeal enhancement noted
Impression:
no significant abnormalities detected in the mri of the brain with and without gadolinium
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again areas of encephalomalacia are redemonstrated in the left occipital lobe causing ex vacuo dilatation of the left occipital ventricular ___ there is persistent uniform hyperintense pattern along the left occipital lobe likely consistent with mineralization from prior chronic infarction unchanged small chronic infarct identified on the right frontal lobe along the precentral gyrus no new diffusion abnormalities are detected to indicate acute subacute ischemic changes the orbits are grossly unremarkable the paranasal sinuses again demonstrate a small polypoid formation in the anterior aspect of the left maxillary sinus possibly representing a small mucus retention cyst
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sequelae of prior infarction identified in the left occipital lobe and right frontal lobe as described above no new areas of restricted diffusion are noted to indicate acute or subacute ischemic changes
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Findings:
there is a large area of low attenuation within the left medial temporal lobe left occipital lobe and extending posteriorly into the posterior limb of the left internal capsule which are most compatible with a left pca territory infarct additional foci of acute to subacute infarcts are seen in the right parietal and right temporal lobes an area of encephalomalacia within the right cerebellar hemisphere is likely sequela from prior insult or infarct there is no intracranial hemorrhage or shift of normally midline structures the ventricles and sulci are normal in size and configuration mucus retention cysts are present within bilateral maxillary sinuses osseous structures are unremarkable
Impression:
1 large acute infarct in the left pca territory as well as additional smaller infarcts in the right parietal and temporal lobes 2 encephalomalacia of the right cerebellar hemisphere likely from prior infarct 3 completely occluded left internal carotid artery with partial reconsitution of the proximal left m1 segment occlusion of distal left m1 with reconstitution of the left m2 segment of the mca likely from leptomeningeal collaterals 3 multifocal areas of stenosis and narrowing particularly involving the right mca right vertebral artery and left eca findings were discussed with dr ___ ___ immediately after completion of the study on ___
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Findings:
the previously reported area of hypoattenuation in the right parasagittal superior frontal lobe demonstrates progressive evolution with encephalomalacia a larger area of encephalomalacia in the inferior right frontal lobe corresponds to the right mca infarction on the prior study there is stable ex vacuo dilatation of the right frontal ___ and no evidence of new hydrocephalus no new territorial infarct or intra- or extra-axial hemorrhages are identified there is mild mucosal thickening of the ethmoid air cells bilateral retention cysts are again seen in the maxillary sinuses
Impression:
1 largely unchanged complex multi-lobed pseudoaneurysm originating from the distal right cervical ica with stenosis of the lumen residual vessel wall and luminal irregularity of the right distal ica due to prior dissection 2 otherwise normal appearance of intra- and extracranial vasculature 2 evolving encephalomalacia in the right superior parasagittal and right inferior frontal lobe from previous infarct
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Findings:
there is redemonstration of left frontal and left occipital encephalomalacia with no acute intracranial hemorrhage mass effect or extra-axial collection ex vacuo dilatation of the left frontal ___ is unchanged there is periventricular white matter hypodensity consistent with chronic small vessel ischemic change elsewhere in the brain ___ matter white matter differentiation is preserved prominence of the ventricles and sulci are compatible with global atrophy the mastoid air cells are clear the visualized paranasal sinuses demonstrate numerous areas of polypoid mucosal thickening in the bilateral maxillary sinuses and mucosal thickening in several ethmoid air cells the patient is status post left frontal craniotomy
Impression:
1 no acute intracranial findings 2 redemonstration of encephalomalacia in the left frontal and left occipital lobes as well as chronic atrophy and periventricular white matter hypodensity consistent with chronic small vessel ischemia dfddp
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Findings:
the previously seen tiny right frontal subdural hematoma has resolved encephalomalacic changes in the left frontal lobe and mild encephalomalacic changes in the right occipital lobe are stable in appearance grey white matter differentiation elsewhere in the brain is normal there is no evidence of new hemorrhage or mass effect a right frontal approach ventricular drainage catheter remains in place with its tip terminating within a cavum septum pellucidum this is unchanged from the prior study ventricular size is stable the osseous structures are unremarkable there is a retention cyst seen in the left maxillary sinus with near complete opacification of the sinus this is unchanged from the prior study the remaining paranasal sinuses and mastoid air cells are clear soft tissues are unremarkable
Impression:
resolution of the previously seen tiny right frontal subdural hematoma otherwise stable appearance of the brain compared to ___
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status post right frontal craniotomy the study is somewhat limited due to motion artifacts there is mild decrease in the flair hyperintense focus in the right frontal region compared to ___ there is also some enhancement noted at the prior surgical site which appears to be smaller compared to the most recent study there is also no change in the small left insular lesion no new foci of abnormal enhancement are noted in the parenchyma or in the leptomeninges the ventricles and extraaxial csf spaces are unremarkable the osseous and the soft tissues structures are normal sinus disease is noted in the left maxillary sinus with moderate mucosal thickening and possibly in bilateral ethmoids
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1 mild decrease in the flair hyperintense area and enhancement in the right frontal region at the site of prior surgery 2 no change in the left insular lesion 3 no new lesions 4 left maxillary moderate mucosal thickening
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Findings:
the patient is status post right frontal craniotomy as seen before there is unchanged enhancement demonstrated in the left insular region and in the right frontal lobe with adjacent flair signal hyperintensities unchanged from the prior study there are no new lesions identified in the brain there is unchanged dural enhancement adjacent to the right frontal craniotomy this likely represents postoperative changes there are multiple periventricular and subcortical deep white matter hyperintensities visualized unchanged to the prior study most likely representing small vessel ischemic changes there is minimal mucosal thickening in the left maxillary sinus there is no evidence of shift of midline structures or hydrocephalus the major vascular flow voids are well preserved
Impression:
1 compared to ___ mri study there are unchanged enhancing lesions in the left insular and right frontal lobe with adjacent flair signal abnormalities they are still concerning for tumor recurrence with adjacent edematous changes continued followup is recommended 2 chronic left maxillary sinusitis
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Findings:
an prior craniotomy defect is seen in the right frontal bone no intra- or extra- axial hemorrhage is identified there is no shift of normally midline structures or mass effect again seen are hypodensities in the left frontal cortex the subinsular regions and the left putamen no new areas of major vascular territorial infarction are appreciated there is stable symmetric prominence of the ventricles the visualized paranasal sinuses and mastoid air cells demonstrate very mild mucosal thickening of the right maxillary sinus the orbits appear unremarkable
Impression:
no change since the prior study of ___
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Findings:
as seen on multiple prior studies there has been a left frontal craniotomy some of the craniotomy defect is probably filled with methacrylate there is stable thin underlying dural enhancement and there is probably an area of hemosiderin at the far anterior aspect of the left frontal lobe unchanged there is ex vacuo dilatation of the body and frontal ___ of the left lateral ventricle there is stable extensive t2 hyperintensity in the deep right frontal white matter as well with more patchy involvement in the parietal white matter bilaterally the temporal horns are not enlarged the residual soft tissue thickening in the right maxillary sinus has resolved
Impression:
1 there is no significant change compared to ___ and ___ 2 there are postoperative changes in the anterior left frontal lobe 3 there is t2 hyperintensity in the deep cerebral white matter likely related to small vessel disease 4 there is no evidence of a recent infarct on the diffusion-weighted images
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Findings:
the patient is status post right frontal and left parietal craniotomies an enhancing lesion is noted in the right frontal lobe series 10 image 18 measuring 7 x 6 6x9 mm and is smaller than the prior study with decrease in the non-enhancing central portion there is also decrease in the surrounding edema the left parietal lesion is not obvious with very minimal enhancement related to the post-surgical changes in this location no obvious new lesions are noted the ventricles and extra-axial csf spaces are normal the major intracranial arterial flow voids are noted the visualized portions of the paranasal sinuses and the mastoid air cells are clear
Impression:
1 decrease in the right frontal lesion with decreased surrounding edema decreased conspicuity of the minimal enhancement noted in the left parietal lobe at the surgical resection site no obvious new lesions continued followup as clinically indicated
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the study is slightly limited by motion artifact there are no areas of abnormal diffusion to indicate acute stroke susceptibility images demonstrate a focus of low signal in the right subcortical white matter corresponding to the lesion seen on the patient's recent ct study of ___ the post-contrast images demonstrate minimal questionable punctate enhancement as such this could represent a tiny focus of hemorrhage with slight associated enhancement there is no shift of the midline structures there is mild-to-moderate atrophy of the brain parenchyma
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1 right parietal lobe lesion with susceptibility and questionable adjacent tiny area of enhancement corresponding to the lesion seen on the patient's prior ct study of ___ this likely represents a small focus of hemorrhage possibly with reactive enhancement 2 brain atrophy likely due to hiv disease
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Findings:
there are no areas of slow diffusion to suggest an acute ischemic stroke there is no mass or areas of abnormal enhancement within the brain parenchyma there is no hydrocephalus or shift of midline structures multiple foci of increased t2 signal scattered throughout the white matter of both cerebral hemispheres and the pons are stable major vascular flow voids are preserved
Impression:
no evidence of mass or abnormal enhancement within the brain parenchyma stable from ___
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Findings:
there are multiple foci of abnormal signal intensity within the brain parenchyma consistent with hemorrhage there are subacute areas of hemorrhage within the left frontal and left parietal lobes as well as an area of likely old hemorrhage within the right parietal lobe associated with malacic change there is no abnormal signal on diffusion weighted imaging to suggest an acute infarction the ventricles and sulci are normal in size and symmetrical there is no shift of normally mid-line structures there are scattered areas of abnormal signal within the periventricular white matter which are non-specific in etiology but could represent areas of microvascular angiopathy please note that no susceptibility weighted imaging was obtained
Impression:
1 multifocal intraparenchymal hemorrhage of various ages coagulopathy is a diagnostic consideration in light of the patient's stated history of hepatic failure
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Findings:
there is no intracranial hemorrhage edema mass effect or vascular territory infarction the ventricles and sulci are normal in size and configuration bilaterally scattered punctate flair hyperintensities in the white matter bilaterally are likely sequelae of chronic microvascular infarction post- contrast images show no abnormal enhancement predominantly csf-signal geographic spaces at the posterior aspect of the occipital lobes bilaterally 7 17 deform adjacent brain parenchyma at an acute angle suggesting intra- axial lesions while non- specific these may represent bilateral developmental cortical defects there are no diffusion abnormalities
Impression:
1 no diffusion abnormality intracranial hemorrhage or abnormal enhancement 2 csf-intensity posterior occipital intra-axial lesions possibly developmental cortical defects please note that such lesions may be associated with seizures
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Findings:
the brain appears to be structurally normal signal intensities of the brain parenchyma are within normal limits no mass effect is seen no shift of normally midline structures seen no abnormal enhancement is noted no susceptibility abnormality is seen no evidence of acute infarction is noted on diffusion-weighted images no evidence of empyema or abscess is seen
Impression:
no evidence of abnormal enhancement or no evidence of abscess or empyema formation the information has been communicated to the referring physician ___ ___ by telephone in the afternoon of ___
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artifacts obscure the right posterior temporal lobe in the posterior fossa on the diffusion images no acute infarct seen in the visualized portions of the brain extensive hyperintensities are visualized in both cerebellum and in the periventricular region with chronic lacunes in both thalami and increased signal in the pons unchanged from previous mri of ___ the pontine abnormality is much better appreciated on the current study which could be secondary to differences in technique some catheters are identified from both left frontal and right occipital region the ventricular size has slightly decreased since the ct of ___ but the temporal horns still remain slightly more prominent compared to the mri of ___ the vascular flow voids are maintained
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1 bilateral shunt catheters identified with slight decrease in ventricular size compared with ___ ct but remains slightly larger compared to the mri of ___ 2 no acute infarct seen or mass effect noted 3 extensive white matter hyperintensities in shunt catheters
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Findings:
there are no acute territorial infarcts seen on diffusion images there is mild generalized sulcal dilatation consistent with mild cortical atrophy no midline shift or mass effect is seen diffusion-weighted images are within normal overall exam is partially degraded by repeated motion artifact there is scattered nonspecific t2 hyperintensity involving the periventricular white matter and centrum semiovale suggestive of chronic microvascular ischemic or gliotic changes normal signal flow voids are seen within the intracranial portions of the carotid and basilar arteries there is a small old lacunar infarct within the right inferior cerebellum
Impression:
chronic periventricular microvascular ischemic changes no acute territorial infarct seen old lacune within the right cerebellum
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Findings:
there is substantial intraventricular blood in all the visualized cerebral ventricles there is a focus of bleeding in the right hemisphere in the white periventricular white matter possibly involving portions of the thalmus a ventricular catheter passes from the left frontal region with its tip terminating in the region of the foramen of ___ there is a low-density zone in the central aspect of the pons which could reflect a pontine infarct either remotely or recently there is no evidence of a focal extra-axial lesion or fluid collection
Impression:
intracranial hemorrhage as described pontine lesion as described
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Findings:
there are multiple foci of restricted diffusion within the distribution of the posterior circulation bilaterally there is a 2 cm region of restricted diffusion within the medial aspect of the right occipital lobe the other small foci are noted within the left posterior parietal lobe at the level of the lateral ventricles the t2 weighted images are markedly limited due to patient motion artifact there is evidence of t2 signal hyperintensity noted within the right occipital lobe lesion as well suggsting that the infarct is subacute in age the evaluation of the left parietal lobe is limited in this regard there is no hydrocephalus the major vascular flow patterns are preserved there are no structural abnormalities detected there are no abnormal foci of susceptibility artifact
Impression:
there is evidence of a subacute ischemic infarct involving the right occipital lobe there are multiple punctate foci of restricted diffusion within the posterior left parietal lobe these findings suggest embolic phenomena in the distribution of the posterior circulation these findings were directly communicated to the clinician caring for the patient at the time of the examination
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Findings:
on diffusion weighted images there is restricted diffusion within the left occipital lobe representing an acute subacute infarct on susceptibility images there are multiple tiny foci of low signal possibly representing petechial hemorrhages along the inferior cortical surface of the left occipital lobe in the region of the infarct this is also seen on the t1weighted images as hyperintensity along the cortical margin on t2w images there are several small foci of signal hyperintensity within the left cerebellar hemisphere but these foci do not demonstrate restricted diffusion or susceptibility artifact and likely represent old lacunar infarcts the ventricles are not dilated there is no shift of normally midline structures there is slight narrowing of the occipital ___ of the left lateral ventricle secondary to mild swelling of the left occipital lobe
Impression:
1 early subacute left occipital infarct 2 old lacunar infarcts of the left cerebellar hemisphere 3 flow appears preserved within the proximal branches of the posterior cerebral arteries
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there are post-surgical changes noted in the right frontal region with areas of gliosis in the right frontal lobe with ex vacuo dilation of the frontal ___ of the right lateral ventricle in addition there are fluid signal intensity areas noted in the inferior frontal lobes likely related to cystic changes there are also a few t1 hyperintense areas noted in the inferior frontal region on the right side seen to extend to the region of the cribriform plates of ethmoid which may relate to the previously noted fat subacute blood content within the lesion there is a small extra-axial fluid collection noted which has decreased in size compared to the prior study measuring approximately 4 mm there is moderate dilation of the lateral and the third ventricles including the temporal horns which may relate to volume loss there is displacement of the anterior cerebral arteries by the cystic changes noted in the inferior frontal lobe on the post-contrast images there is mild linear enhancement of the dura in the right frontal and the parietal regions there is no definite abnormal enhancement noted in the lesion compared to the pre-contrast t1 hyperintense appearance to suggest an obvious tumor the lesion is seen to be in close proximity to the right middle cerebral artery in the ica termination the right mca branches are not well seen however dedicated mr angiogram is not performed on the present study
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1 post-surgical changes with mild dural enhancement and a tiny extra-axial fluid collection in the right frontal and the parietal regions t1 hyperintense areas along with cystic areas are noted in the right inferior frontal lobe without definite enhancement to suggest of enhancing tumor these may represent part of the tumor likely residual in the inferior frontal region extending to the region of cribriform plates of ethmoid to correlate with surgical details attention on close followup to assess stability progression 2 the m1 and m2 branches are not well seen and mildly displaced by the cystic changes dedicated mr angiogram can be considered for better assessment
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Findings:
there are two enhancing lesions in the brain one in the right frontal lobe at the vertex and another one in the left occipital lobe parasagittal in location the right frontal lesion measures 1 5 x 1 7 x 2 0 cm with mild surrounding edema the left occipital lesion measures 3 5 x 3 1 x 2 6 cm there is moderate amount of surrounding edema both the lesions have areas of negative susceptibility representing blood products melanin as well as heterogeneous enhancement with nonenhancing necrotic areas there is effacement of the left occipital ___ and part of the atrium of the left lateral ventricle from the mass effect and surrounding edema around the left occipital lesion there are also a few cystic areas noted in the left occipital lesion the major vascular intracranial arterial flow voids are noted the visualized portions of the paranasal sinuses are clear evaluation for bony lesions is limited mr study there is a prominent extra-axial csf space noted in the superior part of the posterior fossa causing indentation on the superior aspect of the cerebellar hemisphere best seen on the sagittal reformations and measures 1 7 x 3 2 cm in the ap cc dimensions the visualized portions of the paranasal sinuses are clear
Impression:
1 two enhancing lesions in the brain one in the right frontal and another one in the left occipital lobe as mentioned above representing metastatic lesions 2 moderate surrounding vasogenic edema with effacement of the left occipital ___ and part of the atrium of the left lateral ventricle 3 prominent extra-axial csf space in the superior aspect of the posterior fossa causing indentation on the superior part of the cerebellum as described above which can represent prominent csf space with a differential diagnosis of arachnoid cyst in this location
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Findings:
numerous supra- and infratentorial as well as brainstem small enhancing lesions previously seen on mr are for the most part not evident on non-contrast ct of the head there is faint small area of edema in the right frontal lobe which corresponds to previously seen enhancing lesion in this region 2 22 otherwise no large area of edema is seen there are also couple small foci of questionable hyperdensity in regions where enhancing lesions were previously seen for example along the right superior convexity 2 27 where the hyperdensity is along the sulcus and could represent faint calcification rather than blood products in the left cerebellum there is questionable hyperdensity also 2 7 in the region where previous enhancing lesions seen otherwise no large intracranial hemorrhage is seen nor shift of normally midline structures effacement of the basal cisterns hydrocephalus or acute large vascular territory infarction the soft tissues orbits and skull appear grossly intact the visualized paranasal sinuses and mastoid air cells are well aerated vascular calcifications are noted along the left cavernous carotid artery
Impression:
1 couple of faint hyperdense areas in regions previously seen to contain enhancing lesions also small focus of edema in the right frontal lobe corresponding to previously seen enhancing lesion no large area of edema or large acute intracranial hemorrhage seen 2 3 0 x 1 6 cm slightly hyperdense expanding lesion within the sella has unchanged ct appearance but again is incompletely evaluated on non-contrast ct 3 numerous small enhancing lesions in the supra- and infratentorial brain as well as the brainstem are not apparent on ct head without contrast 4 mri can help for better assessment
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Findings:
there is a tiny lesion in the left frontal precentral location measuring approximately 3 8 millimeter mildly increased in size compared to the punctate size on the prior study the right frontal lesion measuring approximately 8 x 7 mm is not significantly changed however there is mild-to-moderate surrounding edema which is mildly increased in size compared to the prior study extending more medially there is no significant mass effect a few nonenhancing small flair hyperintense foci are noted in the cerebral white matter scattered in distribution likely related to small vessel ischemic changes a few small cystic foci are noted in the left frontal lobe not significantly changed bilateral choroid plexus cysts are noted and unchanged the major intracranial arterial flow voids are noted minimal mucosal thickening is noted in the ethmoid air cells and noted in the right mastoid air cells on the left retention cysts are noted in the right maxillary sinus measuring approximately 1 7 x 1 5 cm
Impression:
1 right frontal lesion no significant change in size however there is mild increase in the adjacent edema compared to the recent study in addition the enhancement is more rim like compared to the previously noted nodular enhancement indicating necrosis within 2 mild increase in the size of the tiny lesion in the left frontal lobe at the vertex now measuring 3 mm compared to the previously noted punctate size no new lesions follow up as clinically indicated
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Findings:
compared to the most recent study of ___ the right frontal lesion now measures 2 8 x 2 1 cm in the ap and transverse dimensions along with areas of blood products within compared to the prior of 2 9 x 2 2 cm and is not significantly changed the left parietal occipital lesion measures 3 5 x 3 5 x 3 0 cm is not significantly changed allowing for the technical differences with the obliquely oriented shape of the lesion there is a moderate-sized cystic component noted posteriorly the previously noted surrounding ___ hyperintensity has not significantly changed areas of blood products melena are noted within the lesions the left frontal cortical-based enhancing lesion approximately measures 0 8 x 0 8 cm compared to the prior of 0 8 x 0 8 cm and is not significantly changed the previously noted ___ hyperintensity extending medially from this lesion has resolved extensive confluent white matter ___ hyperintense areas are noted in the cerebral white matter in the frontal and the parietal lobes on both sides as well as in the cerebral peduncles right more than left and unchanged mild dilatation of the lateral ventricles likely relates to volume loss and is unchanged no obvious new lesions are noted a tract with negative susceptibility noted in the left middle cranial fossa likely relates to prior procdure catheter and needs clinical correlation
Impression:
1 no significant change in the size and enhancement pattern in the right frontal left frontal left parietal occipital lesions decrease in the surrounding ___ hyperintense appearance area on the left frontal lesion and no significant change around the other two lesions other details as above no obvious new lesions noted consider close followup if no intervention is contemplated
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motion artifact limits evaluation of detail there are a few small areas of increased flair and t2 signal in the subcortical and periventricular white matter of both cerebral hemispheres these may be related to microvascular ischemia and infarction there is no associated enhancement no diffusion signal abnormality is evident to indicate recent infarction there is no abnormal intracranial susceptibility artifact to suggest the presence of blood products or mineralization the ventricles are not dilated there is no shift of intracranial structures brain morphology is grossly normal the visualized paranasal sinuses and mastoids are clear
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no sign of an enhancing intracranial abnormality or infarction to suggest septic emboli from endocarditis dfdgf
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Findings:
motion artifact degrades the quality of the study there is no evidence of infarction or hemorrhage there are t2 flair hyperintensities in the subcortical and periventricular white matter which are nonspecific but could be seen with chronic microangiopathy there is mucosal thickening of the frontal ethmoidal sphenoid and maxillary sinuses fluid is visualized in both mastoid air cells there is prominence of the ventricles and csf extra-axial spaces consistent with global cerebral volume loss the soft tissues are unremarkable
Impression:
1 no evidence of infarction or hemorrhage however subtle abnormalities could be missed due to significant motion 2 global cerebral volume loss 3 extensive sinus disease
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Findings:
on t2-weighted and flair images there are foci of increased signal intensity in the white matter of the cerebral hemispheres and pons probably reflecting chronic microvascular infarction there is no mass effect or enhancement associated with these findings there is no diffusion signal abnormality to indicate recent infarction no abnormal intracranial susceptibility artifact is identified there is no change in the morphologic appearance of the brain compared to the previous study the ventricles are not dilated following contrast administration no areas of abnormal intracranial enhancement are detected
Impression:
no sign of an enhancing intracranial mass to indicate metastatic disease dfdgf
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Findings:
the study is slightly limited by patient motion artifact areas of increased t2 signal intensity are seen in the right and left centrum semiovale and the left cerebellar hemisphere there are no areas of abnormal susceptibility artifact diffusion-weighted images demonstrate no restricted diffusion with increased signal in the areas of noted t2 hyperintensity there is no midline shift or hydrocephalus opacification is seen of the ethmoid sphenoid and maxillary sinuses unchanged from the ct scan and likely related to the patient's history of intubation the mr angiogram images are markedly ___ due to patient motion artifact signal intensity is seen throughout the circle of ___ and in both internal carotid arteries and vertebral arteries there is some irregularity of the right m1 and m2 segments of the middle cerebral artery but it is unclear whether this is simply artifactual due to motion artifact
Impression:
1 no evidence of acute infarction 2 extensive sinus opacification 3 mr ___ ___ by motion artifact there is some irregularity in the m1 and m2 segments of the right middle cerebral artery but this could simply be artifactual in nature a preliminary report of no acute infarction was discussed by dr ___ ___ with dr ___ ___ in person at the completion of the examination
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Findings:
this study is severely limited due to motion artifact there is no definite intracranial hemorrhage mass effect or ___-white matter differentiation abnormality the ventricles and extra-axial spaces are grossly within normal limits within the limitations of the study subcortical and periventricular white matter hypodensities likely represent chronic microvascular ischemic disease there is no definite depressed skull fracture the paranasal sinuses and mastoid air cells are grossly clear the visualized orbits are grossly unremarkable
Impression:
limited study due to motion artifact no definite acute intracranial abnormality
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on the flair sequence there are several areas of increased signal intensity in bilateral frontal parietal temporal and occipital white matter predominantly in the frontoparietal white matter there is also subtle increased signal in the adjacent cortex however there is no mass effect or enhancement in these lesions on the diffusion-weighted sequence restricted diffusion is noted in the larger lesions in the frontal parietal and the occipital white matter there is no evidence of hemorrhage in these lesions on the gradient echo sequence the ventricles and the extra-axial csf spaces are unremarkable the major vascular flow voids are noted there is mild opacification of bilateral ethmoid sphenoid and left frontal sinuses
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1 multiple areas of flair hyperintensity in bilateral frontal parietal temporal and occipital white matter predominantly in the frontal and parietal lobes with some restricted diffusion no mass effect or enhancement this could most likely represent changes associated with reversible leukoencephalopathy or progressive multifocal leukoencephalopathy superimposed ischemic or infarction changes can be present given the restricted diffusion on the diffusion-weighted sequences 2 metastasis is unlikely given the lack of enhancement findings were discussed with dr ___ at 10 15 p m on ___ by dr ___ ___ dr ___ reviewed the study and edited the report dr ___ ___
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Findings:
on the axial flair sequence there are multiple hyperintense foci in the cerebral white matter periventricular and subcortical in location in the frontal and the parietal lobes there is also possible subtle increased signal adjacent to the cerebral sulci in the right parietal lobe series 7 image 15 focally on the post-contrast images there is no abnormal enhancement noted in these foci hence the significance and the etiology of these findings is uncertain the ventricles are normal in size there is no focus of negative susceptibility or decreased diffusion minimal mucosal thickening is noted in the right maxillary sinus and in the sphenoid sinus the major intracranial arterial flow voids are noted
Impression:
1 multiple flair hyperintense foci in the subcortical and periventricular white matter in the frontal and the parietal lobes along with slightly increased signal intensity adjacent to one of the sulci in the right parietal lobe no enhancement noted the etiology of these findings is uncertain from the present study no priors are available correlate clinically and with labs and csf analysis to evaluate for inflammatory infectious demyelinating etiology neoplastic etiologies are less likely due to lack of enhancement however consider close followup based on the clinical condition to assess stability progression
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Findings:
correlation is made to a ct of the head from the same date there are no intracranial hemorrhages or masses or areas of abnormal enhancement the ___ white matter differentiation is maintained with no areas of slow diffusion the ventricles and extra-axial csf spaces are normal there is minimal amount of subcortical deep and periventricular white matter t2 hyperintensities which likely represent chronic microangiopathic changes the visualized orbits and major flow voids are normal limited views of the hippocampal formation show no asymmetries or abnormalities there is minimal mucosal thickening in the frontal ethmoid sphenoid and maxillary sinuses in the setting of endotracheal and nasogastric tubes no suspicious bony abnormalities are seen
Impression:
chronic microangiopathic changes otherwise normal gadolinium- enhanced mr of the head
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Findings:
again visualized are the multiple flair hyperintense areas in the frontal the parietal and the temporal lobes in the subcortical and periventricular white matter without significant change compared to the prior study of ___ no obvious new lesions infratentorial lesions are noted there is thinning of the corpus callosum the ventricles are prominent likely related to volume loss however there is no significant change compared to the prior study there is new moderate mucosal thickening in the ethmoid air cells on both sides the major intracranial arterial flow voids are noted prominent posterior fossa csf space likely relates to ___ cisterna magna unchanged there is no focus of decreased diffusion or major susceptibility
Impression:
1 several flair hyperintense foci in the frontal parietal and temporal lobe white matter periventricular and subcortical in location not significantly changed in size extent and number compared to the prior study of ___ no obvious new lesions differential diagnosis includes demyelinating disease related to small vessel ischemic changes given the underlying risk factors however the distribution is more characteristic of demyelinating disease such as multiple sclerosis do correlate clinically and with labs follow up as clinically indicated 2 moderate mucosal thickening in the ethmoid air cells
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Findings:
study is somewhat limited due to the patient motion-related artifacts on the flair sequence there are extensive areas of increased signal intensity in the cerebral cortex in the frontal lobes on both sides as well as the left temporal lobe and also in the left frontal subcortical white matter precentral in location - cortex and the subcortical white matter series 3 image 17 on the post-contrast images there is a small enhancing lesion noted in the right frontal lobe periventricular anterior to the frontal ___ better seen on the spin echo post-contrast sequence series 18 image 8 measuring 0 6 x 0 8 cm no other areas of abnormal enhancement are noted while minimal restricted diffusion is possible in the left frontal subcortical white matter region it is not convincing on the adc sequence the ventricles are normal mild prominence of the parietal extra-axial csf spaces is noted posteriorly there is possible extension of the flair hyperintensity from the bifrontal regions on to the hypothalamus and not adequately assessed on the present study the major intracranial arterial flow voids are noted the hippocampi are small on both sides however evaluation limited due to artifacts
Impression:
extensive areas of flair hyperintensity in the cortex in the frontal lobes on both sides as well as left temporal lobe with another focus in the left frontal subcortical white matter a 0 8 x 0 6 mm round enhancing lesion noted in the right frontal lobe anterior to the frontal ___ the differential diagnosis for the flair hyperintense areas includes seizure- associated phenomena drug induced other etiologies like encephalitis viral in etiology however given the small enhancing lesion in the right frontal lobe superimposed inflammatory or infective etiologies less likely neoplastic etiology like metastasis are also in the differential diagnosis followup evaluation in a few days can be considered to assess the stability of the flair signal abnormalities based on the clinical condition correlate with labs to confirm the nature of the enhancing lesion
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there are several foci of increased signal on diffusion images some of which appear to have low intensity on adc map but evaluation of the adc map is limited secondary to small size of the abnormality seen on diffusion images these lesions are seen in both occipital lobes and also in the left frontal and parietal regions none of this foci demonstrate definite enhancement there is no meningeal enhancement mass effect midline shift or hydrocephalus seen there is mild prominence of sulci there is no evidence of acute or chronic blood products
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multiple foci of signal abnormalities on diffusion images with occipital lobe with questionable low adc changes and could suggest acute infarcts some of these infarcts are likely subacute in nature seen in the left frontal and parietal region none of this foci demonstrate enhancement no mri signs of an abscess formation or meningeal enhancement seen no epidural or subdural fluid collection or enhancement seen findings were discussed with dr ___ at the time of interpretation of this study on ___ at 11 a m
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Findings:
the areas of restricted diffusion noted on the previous studies on the diffusion-weighted images and adc maps appear less conspicuous this may indicate interval improvement there are no new areas of restricted diffusion there is no abnormal enhancement after contrast on the flair images a punctate hyperintensity is noted in the left frontal lobe which may represent gliosis of uncertain clinical significance additionally mild prominence of the sulci is noted associated with respect to the patient's age
Impression:
previously described areas of restricted diffusion no longer as conspicuous mild prominence of the sulci for the patient age
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Findings:
on the diffusion-weighted images as well as on the flair axial images there is an area of significant abnormality in the medial left temporal lobe on the adc map an area of decreased signal is identified in this region these findings are suspicious for an area of restricted diffusion which would indicate an acute infarct however given the artifacts in the region a repeat study is recommended for further confirmation there is no mass effect or midline shift seen no evidence of acute or chronic blood products is identified
Impression:
questionable area of restricted diffusion in the medial left temporal lobe for which further evaluation with repeat study is recommended given the artifacts in the same region no mass effect or hydrocephalus
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Findings:
on the adc map there is decreased diffusion identified in the right mca territory extending to the basal ganglia but no corresponding hyperintensities are identified on the diffusion images additionally there are changes hyperintensities on flair and adc map in the white matter of the right occipital lobe with a restricted diffusion along the cortex there is a signal abnormality also seen in the right cerebellum with mass effect on the fourth ventricle which does not demonstrate definite restricted diffusion on the adc map no evidence of microhemorrhage is seen no midline shift or hydrocephalus seen
Impression:
the appearances of the right cerebral and cerebellar hemispheric abnormalities particularly the involvement of the right occipital lobe posterior parietal lobe and right cerebellar hemisphere are not typical for an acute infarct these areas were normal on the previous ct examination of ___ although there is restricted diffusion seen in the right middle cerebral territory on the adc map which could indicate infarct there is no corresponding diffusion abnormality on the diffusion images seen overall these findings are suspicious for possibility of ischemia associated with inflammatory changes given patient's history of systemic infections this could represent cerebritis cerebellitis if clinically indicated and patient's condition permits gadolinium-enhanced imaging would help for further assessment along with repeat diffusion and flair images findings were discussed with dr ___ at the time of interpretation of the study on ___ at 2 30 p m
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Findings:
on diffusion images no evidence of slow diffusion is seen the ventricles and extraaxial spaces are normal in size there is no evidence of midline shift mass effect or hydrocephalus seen there is mild prominence of sulci inappropriate for patient's age there is no evidence of focal signal abnormalities seen within the brain following gadolinium no evidence of abnormal parenchymal vascular or meningeal enhancement identified
Impression:
no evidence of abnormal signal or abnormal enhancement within the brain no evidence of acute infarct mild age-inappropriate prominence of sulci
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the examination is limited secondary to motion artifact again seen is the heterogeneous 4 4 ap x 4 9 tv x 4 2 cc cm mass centered within the right temporal lobe with surrounding vasogenic edema exerting mass effect on the right lateral ventricle the degree of leftward subfalcine and uncal herniation is unchanged the mass is hypointense on t1- weighted images and heterogeneous but predominantly hyperintense on t2- weighted images there is a thick irregular enhancing rim with central necrosis foci of increased susceptibility within this mass likely represent blood products the remainder of the examination is unremarkable for a small area of flair hyperintensity in the left occipital lobe 8 10 which does not demonstrate enhancement following gadolinium administration although evaluation is limited secondary to the motion artifact
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1 heterogeneous right temporal lobe mass with leftward subfalcine herniation and uncal herniation 2 small focus of increased flair signal within the left occipital lobe which is not completely evaluated repeat mri is recommended for further evaluation
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Findings:
there is a large mass identified in the left occipital lobe which has heterogenous signal on t2-weighted images and demonstrate intense homogeneous enhancement following the administration of gadolinium the mass measures approximately 4 cm in the greatest dimension the mass appears predominantly intraventricular within the occipital ___ of the left lateral ventricle there is surrounding edema seen in the white matter in addition there is an additional approximately 2 cm mass identified arising from the superior aspect of the left tentorium and abutting the intraventricular mass surrounding edema is also identified the signal characteristics and the appearance as well as the enhancement pattern of these mass lesions are suggestive of meningeoma there is mild midline shift to the right side there is no hydrocephalus seen there is no acute infarct identified
Impression:
1 large intraventricular mass in the occipital ___ of the left lateral ventricle consistent with meningioma 2 smaller approximately 2-cm mass at the superior aspect of the left tentorium consistent with meningioma surrounding edema is seen in the left occipital lobe 3 mild midline shift to the right side 4 no evidence of hydrocephalus or acute infarct
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Findings:
again flair abnormality is seen in the left medial temporal lobe involving the hippocampus and the uncus as well as the temporal lobe area adjacent to the left temporal ___ some pre-gadolinium t1 hyperintensities are seen in this region following gadolinium there is enhancement seen in this region which is somewhat inhomogeneous and irregular in appearance compared to the prior study the enhancement has increased an estimation of the volume of enhancement shows a volume of 6 6 cc on the previous study compared to 9 6 cc on the current study previously noted small area of hyperintensity in the left frontal lobe which could be related to placement of prior ventricular catheter is unchanged the flair abnormality in the left temporal lobe may be slightly increased there is no midline shift seen
Impression:
increase in size of enhancement and slight increase in flair abnormalities in the left temporal lobe region as described above the left temporal lobe enhancement has increased from 6 6 cc to 9 6 cc findings were discussed with dr ___
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Findings:
limited examination due to patient motion right frontotemporal craniotomy is redemonstrated after the administration of gadolinium contrast similar pattern of nodular enhancement is identified at the surgical site involving the region of the right temporal lobe measuring a approximately 25 4 by 42 10mm in transeverse dimensions with similar pattern of vasogenic edema and asymmetry of the right temporal ventricular ___ and sulci diffuse areas of encephalomalacia are demonstrated in the subcortical white matter relatively unchanged since the prior study and involving the corpus callosum and both centrum semiovale the ventricles and sulci are prominent and unchanged small focus of abnormal enhancement is again demonstrated on the left frontal lobe image 12 series #10 measuring approximately 6 x 5 mm in size and associated vasogenic edema image 12 series #10 no new lesions are identified normal flow void signal is noted at the major vascular structures the orbits are unremarkable the paranasal sinuses and the mastoid air cells are grossly normal
Impression:
1 relatively stable and unchanged tumor resection area involving the right temporal lobe with similar pattern of enhancement vasogenic edema and enlargement of the right temporal ventricular ___ and sulci 2 unchanged focus of abnormal enhancement in the left frontal lobe concerning for glial neoplasm no new lesions are identified since the most recent examination
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Findings:
there is an area of abnormal signal intensity measuring 2-3 cm in greatest dimension within the right temporal lobe in the region of the operculum the signal characteristics of this lesion are consistent with hemorrhage there is abnormal signal intensity in the surrounding temporal lobe and extending into the inferior frontal lobe and insular cortex suggestive of vasogenic edema this temporal lobe mass demonstrates mild heterogenous enhancement on post-gadolinium images directly anterior to the previously described lesion there is a subcentimeter ring-enhancing mass within the anterior right temporal lobe in the medial inferior frontal lobe in the paraseptal region there is a small poorly defined region of signal abnormality that also enhances after the administration of intravenous contrast in the high medial right anterior frontal lobe near the falx there is a fourth area of abnormal signal intensity demonstrated on flair images this fourth lesion does not enhance after intravenous contrast administration the cerebrospinal fluid spaces are normal in size and symmetrical the major vascular flow voids are preserved there is no midline shift or major mass effect
Impression:
hemorrhagic right temporal lobe mass with surrounding edema it is not entirely clear if this represents a pure hemorrhage or if there is an underlying tumor additional areas of cerebral signal abnormality with enhancement are also identified this is suspicious for metastatic disease prostate cancer very rarely metastases to the brain also possible but perhaps less likely etiologies for these lesions include vasculitis or an infectious process
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the patient is now status post resection of the left posterior frontal mass post-surgical changes are present in this region there is no definite evidence of residual enhancement no other enhancing lesions are seen within the brain there is a moderate amount of residual edema in the surgical bed
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no evidence for residual enhancement in the operative bed
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Findings:
again seen are right frontal surgical changes with a large defect corresponding to the prior position of an enhancing right frontal mass there is mild peripheral enhancement that is somewhat nodular on its anterior and lateral surfaces this finding raises the possibility of residual tumor however the extent of enhancement surrounding the surgical site is within the range expected on a postoperative basis alone after several weeks there has been a dramatic reduction in the extent of right frontal edema since the prior study flair and t2-weighted images were not performed at this time thus detailed assessment of edema is limited no new abnormalities are detected no other enhancing lesions are identified
Impression:
postoperative changes with dramatic reduction in the right frontal edema since the study of ___ no new lesions are identified ring enhancement at the surgical site raises the possibility of residual tumor but is compatible with postoperative enhancement
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Findings:
minimal amount of edema is noted within left frontal lobe subjacent to the resection bed though evaluation of this region is partly limited by the artifact from the recent surgery no residual enhancement is noted within the resection bed to suggest residual tumor no other focus of abnormal enhancement is identified no other mass mass effect hemorrhage or infarction is noted
Impression:
status post resection of left frontal meningioma with minimal amount of edema subjacent to the resection bed no evidence of residual tumor
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Findings:
patient is status post left frontal craniotomy and mass resection with significant decrease in local mass effect there is still approximately 3 mm of rightward shift which is decreased from 10 mm on the prior study there is stable amount of vasogenic edema in the left frontal lobe with blood and air within the surgical bed there is also overlying soft tissue edema as would be expected there is some enhancement within the left frontal lobe extending to the tip of the left frontal ___ of the lateral ventricle that may be due to postoperative change or could be related to persistent tumor presence this should be followed there is otherwise no evidence of hemorrhage or infarction there are no diffusion abnormalities
Impression:
expected post-surgical appearance after left frontal craniotomy and mass resection with blood and air at the resection site persistent vasogenic edema in the left frontal lobe with residual enhancement extending to the frontal ___ of the left lateral ventricle that may be post-surgical change or residual mass recommend continued followup
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Findings:
since the previous mri study the patient has undergone resection of the right frontal enhancing mass lesion air and blood are seen at the surgical site following gadolinium residual enhancing mass is identified at the inferior posterior aspect of the lesion there is no midline shift or hydrocephalus seen hyperintensities in the right frontal lobe are again noted due to edema on t2 and flair images there are no other enhancing lesions identified
Impression:
status post resection of right frontal lesion blood products and air are seen in the surgical site small amount of residual enhancement is noted at the inferior posterior aspect of the lesion in the right frontal lobe no evidence of acute infarct mass effect or hydrocephalus seen
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there are numerous small foci of slow diffusion involving the cortex and white matter of the cerebral hemispheres the lentiform nuclei the right cerebellar peduncle and the cerebellum bilaterally these are consistent with acute infarctions since multiple bilateral vascular territories are involved the etiology is likely embolic multiple small t2 hyperintensities are also seen in the supratentorial white matter without associated diffusion abnormalities likely related to chronic small vessel ischemic disease the ventricles and sulci are normal in size and configuration without evidence of cerebral edema or cerebral atrophy a portion of the flow void of the cavernous right internal carotid artery is poorly visualized most likely due to volume averaging a mucous retention cyst is again seen in the left maxillary sinus
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numerous small acute infarctions throughout the supratentorial and infratentorial brain in multiple vascular territories suggestive of central embolic etiology findings reported to dr ___ at 3 40 p m on ___
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Findings:
the patient is intubated there is large chronic infarct which occupies most of the right middle cerebral artery territory a smaller focus of hypodensity along the right parieto-occipital junction is also consistent with prior infarction elsewhere particularly in the subcortical white matter of the left frontal lobe there is hypodensity that is most suggestive of chronic small vessel ischemic disease there is no evidence of intracranial hemorrhage the sulci and ventricles are prominent consistent with atrophy related to prior volume loss in the right cerebral hemisphere is ex vacuo dilatation of the right lateral ventricle mucosal thickening is present in the sphenoid sinus which may relate to intubation the osseous structures are unremarkable cavernous carotid artery calcifications are noted
Impression:
1 no evidence of intracranial hemorrhage 2 evidence of prior infarcts in the right cerebral hemisphere in particular a large chronic-appearing infarction involving the right middle cerebral artery territory
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Findings:
there is no slow diffusion to suggest acute infarction again noted is left frontal craniotomy and left frontal encephalomalacia with associated siderosis evident on gradient echo images siderosis is also again noted along the right frontal lobe previously noted leptomeningeal contrast enhancement is not re-evaluated on this noncontrast study again seen is a tiny chronic infarct in the right cerebellar hemisphere there are multiple unchanged foci of high t2 signal in the periventricular white matter of cerebral hemispheres likely representing chronic small vessel ischemic disease there is unchanged prominence of the ventricles and sulci indicating global cerebral atrophy multiple small mucus retention cysts are seen in the maxillary sinuses mri of the circle of ___ the intracranial vertebral and internal carotid arteries and their major branches appear patent without evidence of stenosis occlusion or aneurysm formation
Impression:
1 no evidence of an acute infarct 2 unchanged left frontal encephalomalacia with siderosis underlying the left frontal craniotomy unchanged right frontal siderosis previously noted leptomeningeal contrast enhancement is not re-evaluated on this noncontrast study 3 no evidence of hemodynamically significant arterial stenosis in the head or neck
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Findings:
this study is somewhat limited due to motion-related artifacts there is no obvious focus of slow diffusion to suggest an acute infarct there are a few scattered flair hyperintense foci in the periventricular and subcortical white matter in the frontal lobes and a few in the parietal lobes there is moderate dilation of the lateral and the third ventricles along with a prominent cerebral aqueduct and temporal horns which is out of proportion to the mildly prominent cerebral sulci while part of this may relate to volume loss an associated communicating hydrocephalus such as nph cannot be completely excluded prominent cerebral sulci are noted at the vertex related to volume loss the major intracranial arterial flow voids are noted however the internal carotid arteries appear tortuous in the cavernous and supraclinoid segments no large area of negative susceptibility is noted there is diffuse increased signal intensity in the mastoid air cells on both sides from fluid and mucosal thickening there is also moderate amount of fluid in the sphenoid sinus and mild-to-moderate mucosal thickening in the ethmoid air cells and in the frontal sinus diffuse hypointense signal of the marrow is noted related to anaemia myeloproliferative or infiltrative disorders
Impression:
1 study limited due to motion-related artifacts within this limitation there is no obvious focus of slow diffusion to suggest an acute infarct no mass effect 2 moderate dilation of the lateral and the third ventricles as described above which may relate to volume loss or communicating hydrocephalus such as nph correlate clinically 3 diffuse mucosal thickening and fluid in the mastoid air cells moderate amount of fluid in the sphenoid sinus and mild-to-moderate mucosal thickening in the ethmoid air cells 4 diffuse hypointense signal of the marrow is noted related to anaemia myeloproliferative or infiltrative disorders correlate with hematology labs
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Findings:
there is a wedge shaped area of hypoattenuation within the right cerebellar hemisphere concerning for acute infarct the left cerebellar hemisphere appears within normal limits bilateral periventricular and scattered subcortical white matter hypodensity is likely sequelae of chronic microvascular ischemic disease a focal hypoattenuation within the periventricular white matter of the left occipital lobe is noted measuring 1 2 cm and may represent sequela of an old infarction there is fluid within the nasopharynx and sphenoid sinuses likely related to intubation coarse calcifications are noted within bilateral cavernous carotid arteries there is a left 1 1-cm ___ bullosa
Impression:
1 acute right cerebellar infarct mri with diffusion- weighted imaging would be helpful for further evaluation of this finding 2 confluent periventricular and scattered subcortical white matter hypoattenuation consistent with chronic microvascular ischemia 3 fluid within the nasopharynx and sphenoid sinuses likely related to intubation sesha
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the patient is status post right suboccipital craniotomy with associated post- surgical changes including blood products slightly decreased when compared to the prior exam surgical mesh is seen covering the osseous defect there is stable predominantly linear enhancement surrounding the resection cavity site there is a focal 2 6 x 0 5 cm focus of enhancement in the posterior superior aspect of the resection cavity site consistent with residual tumor seen best on the coronal images this is seen abutting the inferior and anterior portion of the right transverse venous sinus and suggests at least partial invasion there has been slight interval increase in flair signal hyperintensity along the anterior aspect of the resection cavity site which may represent post- surgical post- treatment changes no other enhancing lesions are identified there are stable patchy nonenhancing t2 flair hyperintensities involving the bilateral centrum semiovale and periventricular regions likely representing chronic microangiopathic small vessel ischemic changes in a patient of this age there is mild diffuse parenchymal volume loss with associated proportional prominence of the ventricles and sulci likely reflecting age- related volume loss no hydrocephalus is identified the major vascular flow voids are unremarkable orbital structures are unremarkable there is stable fluid within the right mastoid air cells and right petrous apex otherwise the left mastoid air cells demonstrate mucosal thickening the paranasal sinuses are clear
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1 stable focus of enhancement along the posterior superior aspect of the resection cavity site adjacent to the right transverse sinus most consistent with residual tumor 2 status post right suboccipital craniotomy with associated post- surgical changes
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Findings:
the patient is status post suboccipital craniotomy there are associated stable post-surgical changes including blood products at the resection cavity site in the left cerebellar hemisphere vermis there is a small stable 7 8 x 6 8 mm focus of enhancement in the posterior aspect of the resection cavity site not significantly changed when compared to the prior exam there is stable flair signal abnormality surrounding the resection cavity site there has been slight interval increase in nonenhancing flair hyperintensity within the right lateral aspect of the medulla due to the signal intensity characteristics and absence of enhancement this appears unlikely to be tumor progression however it may reflect wallerian degeneration corellation with clinical evaluation and continued close follow up is recommended there is a stable shunt tract and burr hole extending from the right frontal region into the frontal ___ of the right lateral ventricle there are stable non-enhancing t2 flair hyperintensities within the bifrontal subcortical white matter centrum semiovale corona radiata and periventricular region likely representing chronic microangiopathic small vessel ischemic changes in a patient of this age the ventricles are stable in size without evidence of hydrocephalus orbital structures are unremarkable the paranasal sinuses and mastoid air cells are clear
Impression:
1 slight interval increase in non-enhancing flair hyperintensity within the right lateral aspect of the medulla this may represent wallerian degeneration this should be followed on subsequent imaging due to increase in size to rule out a secondary lesion 2 stable nodule of enhancement in the posterior aspect of the left cerebellar vermal resection cavity site 3 status post suboccipital craniotomy with stable post-surgical changes
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Findings:
post-surgical changes are noted status post right temporal craniotomy with a small fluid collection overlying the craniotomy site measuring 3 0 x 0 7 cm additionally there is t1 hyperintensity within the right frontal sinus consistent with the revision fat packing since the prior study there has been significant interval decrease in the degree of edema in the right hemisphere there is a small area of residual t2 and flair hyperintensity in the right temporal lobe measuring 6 5 cubic cm which is significantly decreased since the prior examination there is a small single focal area of nodular enhancement along the periphery of the resection cavity there is mild leptomeningeal enhancement overlying the resection cavity which is smooth in appearance likely post-surgical in nature remainder of the brain parenchyma demonstrates stable appearance there is no midline shift mass effect or evidence of a space-occupying lesion there is no new focus of abnormal enhancement the ventricles sulci and cisterns remain mildly prominent but unchanged there are scattered areas of t2 and flair hyperintensity in the periventricular and subcortical white matter stable since the prior study there is no decreased diffusion to indicate an acute infarct the flow voids of the major vessels are present there is extensive fluid within the mastoid air cells bilaterally mild mucosal thickening is noted in the visualized paranasal sinuses in addition to the hyperintensity related to the fat packing in the right frontal sinus the orbits and soft tissues are otherwise intact
Impression:
post-surgical changes status post right temporal craniotomy and resection of a right temporal lobe mass as well as revision for a csf leak with fat packing in the right frontal sinus a small focus of residual nodular enhancement in the resection bed may represent post-treatment related changes but a small focus of residual neoplasm cannot be excluded continued close interval followup imaging as per the oncologic protocol is recommended
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Findings:
postoperative changes are noted patient is status post left frontal craniotomy there has been interval decrease in intrinsic t1 hyperintensity along the tract extending from the peripheral left frontal lobe into the left lateral ventricle in the surgical pathway for resection of the left ventricular subependymoma there is persistent blooming artifact within this left frontal tract as well as in the immediate periventricular region representing post-surgical changes there has been interval decrease in the smooth homogeneous dural enhancement within the supratentorial region likely representing post-surgical changes there is no evidence for abnormal enhancement within the tract or subependymal region to suggest residual or recurrent tumor mr ___ ___ no differential or increased ___ there are stable scattered patchy flair hyperintensities in the bilateral centrum semiovale corona radiata and periventricular regions likely representing chronic microangiopathic small vessel ischemic changes in a patient of this age there is mild diffuse parenchymal volume loss with associated prominence of the sulci likely age related there is no evidence for acute infarct there is stable asymmetric configuration and size of the lateral ventricles larger on the left than on the right unchanged when compared to the prior exam there are mucosal retention cysts in the left maxillary antrum there is a small air-fluid level in the left maxillary antrum new there is aerosolized secretions within the bilateral sphenoid sinuses new when compared to the prior examination there is mucosal thickening of the bilateral ethmoid air cells there is fluid within the right mastoid air cells the left mastoid air cell is clear the orbital structures are unremarkable
Impression:
1 postoperative changes within the left frontal lobe as detailed above with no evidence for intraventricular or parenchymal enhancement to suggest residual recurrent tumor 2 interval decrease in smooth supratentorial dural enhancement suggesting resolving post-surgical dural enhancement 3 interval development of aerosolized secretions within the bilateral sphenoid sinuses and air-fluid level in the left maxillary antrum this can be seen in acute sinusitis
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Findings:
post-surgical changes are again noted status post left frontal and parietal craniotomy and resection of a left frontal lobe mass the resection cavity is stable in appearance with areas of intrinsic t1 hyperintensity and susceptibility surrounding the resection margin with additional areas of apparent nodular enhancement along the resection margin as well as areas of decreased diffusion all of which appears stable there is no evidence of increased perfusion along the resection margin confluent reas of t2 and ___ hyperintensity are again noted in the periventricular and subcortical white matter especially in the centrum semiovale and corona radiata extension into the left midbrain and pons is stable in appearance and likely represents wallerian degeneration there is no new focus of abnormal enhancement or new area of t2 ___ hyperintensity the ventricles sulci and cisterns have a stable configuration there is no midline shift there is no acute intracranial hemorrhage the extra-axial collection overlying the left hemisphere and in communication with the resection cavity is stable in appearance flow voids of the major vessels are present the visualized orbits are unremarkable a collection overlying the left craniotomy site is again noted and stable in size and appearance the visualized paranasal sinuses and mastoid air cells are clear
Impression:
post-surgical changes status post resection of a left frontal lobe mass with findings most likely representing the sequela of treatment the decreased diffusion and enhancement surrounding the resection margin may be related to treatment with avastin however a small focus of residual neoplasm cannot be excluded and continued followup as per oncologic protocol is recommended
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limited study due to motion artifact there are subtle dwi signal in the pons with no evidence of abnormal signal on adc likely artifaact there are no foci of slow diffusion to suggest acute ischemia no foci of susceptibility artifact to represent hemorrhage there is no abnormal enhancement there are numerous subcortical periventricular and deep white matter t2 flair hyperintense lesions the ventricles cisterns and sulci are age-appropriate the major intracranial flow voids including those of the major dural venous sinuses are preserved no shift of the midline structures or central herniation is identified the orbits and globes are unremarkable there is fluid in the ethmoid and bilateral mastoid air cells the visualized bones and soft tissues are within normal limits
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1 no evidence of acute hemorrhage infarct or abnormal enhancement 2 bilateral mastoid and ethmoid fluid clinical correlation is recommended
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Findings:
there is a 6 1 x 4 7 cm left frontal intraparenchymal hemorrhage with mass effect over the left lateral ventricle and 5 mm midline shift to the right small amount of right subarachnoid hemorrhage the hemorrhage contains acute and subacute components and demonstrates no evidence of abnormal enhancement there are no foci of slow diffusion to suggest acute ischemia there are periventricular t2 flair lesions likely representing chronic ischemic changes the major intracranial flow voids including those of the major dural venous sinuses are preserved the orbits and globes are unremarkable the paranasal sinuses and mastoid air cells are well aerated the visualized bones and soft tissues are within normal limits
Impression:
6 1 x 4 7 cm left frontal intraparenchymal hemorrhage with mass effect over the left lateral ventricle and 5 mm midline shift to the right slighty larger since the prior exam but may be due to differences in technique the hemorrhage contains acute and subacute components there is small amount of right subarachnoid hemorrhage there is no evidence of underlying enhancing mass short term follow up is recommended
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Findings:
"there is unavoidable patient motion artifact secondary to very labored breathing per technologist note there are some punctate parenchymal foci of t2 flair-hyperintensity additional note is made of flair-hyperintensity adjacent to the atria of the lateral venrticles bilaterally which may be subependymal there is flair hyperintensity within the subarachnoid spaces of the bilateral temporal parietal and occipital lobes this flair hyperintensity is less evident on the ""propeller"" motion-corrected scan and may be artifactual to some extent the ___-white matter differentiation is otherwise preserved there is moderate bifrontal cortical atrophy advanced for the patient's age the ventricles and cortical sulci are otherwise normal in size and configuration without evidence of mass effect or shift of the normally midline structures the principal intracranial arterial flow voids are patent the visualized paranasal sinuses and mastoid air cells are well aerated there is no evidence of restricted diffusion to suggest acute ischemia or susceptibility artifact on gradient echo images to suggest hemorrhage"
Impression:
1 motion-degraded study demonstrating no evidence of acute infarction or hemorrhage 2 flair-hyperintensity within the subarachnoid space less convincing on the motion-corrected study while this finding may be related to motion artifact underlying leptomeningeal process with proteinaceous content or abnormal inflammatory cells within the subarachnoid space is not excluded this finding should be correlated with results of lumbar puncture none are present on omr 3 non-specific t2 flair-hyperintense foci in parenchymal and questionable subependymal white matter possibly unrelated to the current presentation and representing sequelae of chronic microvscular ischemic disease
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Findings:
study is limited due to motion-related artifacts on multiple sequences within this limitation on the diffusion sequences there is no focus of slow diffusion to suggest an acute infarct there is asymmetry in the size of the lateral ventricles with the left being slightly larger than right on the flair sequence there are several areas of hyperintense signal involving predominantly the cortex in the frontal parietal and the occipital lobes as well as in the left medial temporal lobe small areas of involvement in the adjacent white matter are also seen there is no abnormal enhancement noted in these areas there is no focus of negative susceptibility to suggest hemorrhage allowing for the areas of mineralization patient is intubated there is mildly increased signal intensity in the mastoid air cells on both sides from fluid mucosal thickening the major intracranial arterial flow voids are noted
Impression:
1 several areas of flair hyperintense signal in the cerebral parenchyma - the etiology of these findings is uncertain a broad differential diagnosis including encephalitis seizure-induced changes either reactive or inflammatory changes or related to medication toxic etiology clinical and lab correlation and close followup can be considered to assess stability 2 patent major intracranial arteries as described above with evidence of mild contour irregularity related to atherosclerotic disease discussed with m frank by n peri on ___ at 9 20pm by phone
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Findings:
there is no acute intracranial hemorrhage infarction edema mass or mass effect seen ventricles and sulci are age appropriate there is no abnormal leptomeningeal or parenchymal enhancement seen there is a partially empty sella turcica seen major intracranial flow voids are preserved visualized orbits and paranasal sinuses are unremarkable mild fluid signal is seen in the mastoid air cells bilaterally there are few scattered t2 flair hyperintensities seen in the periventricular subcortical and deep white matter bilaterally
Impression:
1 no acute intracranial abnormality no abnormal enhancement seen 2 small vessel ischemic disease
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the study is moderately limited due to motion artifacts especially on the sagittal t1 and axial flair sequences on the axial flair sequence there are multiple hyperintense areas in the bilateral cerebral white matter subcortical and periventricular in location without significant change on the diffusion-weighted sequence there are three tiny hyperintense foci one in the right posterior parietal lobe white matter series 402 image 20 another one in the left posterior temporal lobe medially series 402 image 12 and in the left parietal lobe series 402 image 15 these do not have definite corresponding abnormality on the adc sequence however this could still represent acute infarcts which have normalized on the adc 2 of the lesions on the left side do not have corresponding flair abnormality slightly prominent ventricles and cerebral fissures are noted related to age- appropriate parenchymal volume loss there is mild increased signal in the right mastoid air cells the remainder of the visualized paranasal sinuses are clear the major vascular flow voids are noted bilateral basal ganglia calcification and dural calcification noted without significant change 3d tof mr angiogram of the head the study is limited due to motion artifacts within these limitations the distal vertebral basilar posterior cerebral intracranial internal carotid anterior middle cerebral and the communicating arteries are patent no focal flow-limiting stenosis or occlusion is noted no obvious aneurysm is noted in these vessels however assessment for small aneurysms is limited due to motion artifacts mild contour irregularity of the intracranial internal carotid arteries the posterior cerebral and middle cerebral arteries is noted which could be related to atherosclerotic disease
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1 three tiny foci hyperintense on the diffusion-weighted sequence in the right parietal lobe white matter left posterior temporal and left parietal lobe without corresponding abnormality on the adc sequence which can represent acute infarcts normalized on the adc these are new since the prior study done on ___ given the distribution of these foci embolic etiology is likely to be considered to correlate clinically 2 mr angiogram of the head limited due to motion artifacts within these limitations no focal flow-limiting stenosis or occlusion of the major intracranial arteries noted contour irregularity of the intracranial internal carotid arteries and the posterior cerebral and middle cerebral arteries is noted likely related to atherosclerotic disease mr angiogram of the neck not performed as the patient could not continue through the study findings were discussed with dr ___ english by dr ___ on ___ at 8 45 a m
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Findings:
there is empty sella noted on the sagittal t1-weighted sequence mild degenerative changes are noted in the visualized cervical spine causing mild indentation on the ventral thecal sac on the axial flair sequence there are a few scattered small foci of hyperintensity in the cerebral ___ matter on both sides in the frontal and the parietal lobes these are not associated with abnormal susceptibility restricted diffusion or abnormal enhancement the ventricles and extra-axial csf spaces are mildly prominent related to mild diffuse volume loss age appropriate no abnormal foci of enhancement are noted in the brain parenchyma or in the meninges to suggest definite intracranial metastatic disease a small focus of enhancement noted in the superior portion of the left cerebellar hemisphere on the surface series 1000 image 17 has no associated abnormality on the flair sequence and is not clearly identifiable on the spin echo sequences series 1001 image 78 the major vascular arterial flow voids are noted the visualized portions of the paranasal sinuses are clear there is diffuse increased signal intensity in the left mastoid air cells which can represent fluid and or mucosal thickening
Impression:
1 no definite evidence of intracranial metastatic disease however a small 3-mm area of enhancement noted in the superior portion of the left cerebellar hemisphere close to its surface without corresponding abnormality on the flair sequence and spin echo post-contrast sequences needs followup evaluation in six eight weeks to assess stability progression and to exclude metastatic involvement in this location no surrounding edema or mass effect noted 2 evidence of sequelae of chronic small vessel occlusive disease in the brain as described above 3 incidental findings of empty sella left mastoid fluid mucosal thickening
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Findings:
mri of the brain there are no areas of restricted diffusion to suggest acute infarction on the flair sequence there are multiple hyperintense areas in the cerebral white matter predominantly periventricular in location and a few smaller ones in the subcortical white matter and centrum semiovale likely related to sequela of chronic small vessel occlusive disease there are also areas of increased signal intensity in the splenium of the corpus callosum which may be related to the same process or earlier demyelinating lesions if there is correlating history there are no areas of abnormal susceptibility the major vascular flow voids are noted the ventricles and extra-axial csf spaces are mildly prominent related to mild diffuse parenchymal volume loss which may be age appropriate the visualized portions of the paranasal sinuses and the mastoid air cells are clear except for a small area of increased signal in the right maxillary sinus which can represent a small area of retention cyst versus polyp the patient is status post ocular lens surgery on the left side on the sagittal t1-weighted images there were degenerative changes noted in the upper cervical spine at the level of c4-5 with endplate changes not completely assessed on the present study small disc osteophyte complex is noted at this level causing mild indentation on the thecal sac 3d tof mr angiogram of the head the major intracranial arteries of the anterior and the posterior circulation are patent with some stenosis of the cavernous segments of the internal carotid arteries on both sides along with contour irregularity likely related to atherosclerotic disease however there is no flow limitation occlusion or aneurysm more than 3 mm within the resolution of mr angiogram the a1 segment of the right anterior cerebral artery is not visualized and likely absent representing a variant
Impression:
1 no acute infarction 2 multiple flair hyperintense areas in the cerebral white matter - centrum semiovale subcortical and periventricular white matter as well as in the corpus callosum which may be due to sequelae of chronic small vessel occlusive disease with or without other causes like demyelinating lesions if there has been correlating history in the past 3 patent major intracranial arteries on the non-contrast mr angiogram some degree of irregularity and stenosis of the cavernous segments of the internal carotid arteries on both sides moderate stenosis of the proximal left cervical internal carotid artery at its origin 0 7cm in length without flow limitation distally more accurate assessment is limited due to lack of contrast- enhanced mr angiogram carotid doppler can be considered for better assessment 4 degenerative changes in the cervical spine as described above
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Findings:
there is a small focus of decreased diffusion in the right periventricular white matter in the parietal lobe series 10 image 14 series 9 image 14 represents a small acute infarction punctate focus in the left occipital lobe se 10 im 13 is of equivocal significance on the axial flair sequence there are multiple flair hyperintense foci noted in the centrum semiovale the periventricular and subcortical white matter in the frontal and the parietal lobes are likely nonspecific in etiology given the patient's age this may relate to small vessel ischemic changes the ventricles and extra-axial csf spaces are mildly prominent related to mild volume loss along with cerebral sulci and sylvian fissures there is diffuse increased signal intensity in the mastoid air cells on both sides from fluid mucosal thickening the major intracranial arterial flow voids are noted the visualized portions of the paranasal sinuses reveal mucosal thickening in the right side of the frontal sinus frontoethmoidal recess in the right anterior ethmoid air cells and the left side of the sphenoid sinus 3d tof mr angiogram of the head the major intracranial arteries of the anterior and the posterior circulation are patent without focal flow-limiting stenosis occlusion or aneurysm more than 3 mm within the resolution of mr angiogram the right posterior inferior cerebellar artery is not clearly visualized however the right anteroinferior cerebellar artery appears to be prominent and may be supplying both territories there is fetal pca pattern noted on the left side with absent p1 segment the intracranial internal carotid arteries reveal mild contour irregularities related to atherosclerotic disease ther eis narrowing note din the m2 branches on the left side on the reformations however appear groslly patent on the source images
Impression:
1 small focus of acute infarction in the right parietal periventricular white matter patent major arteries without flow-limiting stenosis occlusion or aneurysm more than 3 mm within the resolution of mr angiogram to correlate clinically for the etiology embolic occlusion of distal branch on the right mca territory d w dr ___ ___ by dr ___ on ___ wet read entered on ___ 2 nonvisualization of the right posterior inferior cerebellar artery- low origin normal variant narrowing of the left m2 branches more prominent on the 3d reformations technical correlation with cta head can be helpful
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Findings:
an equivocal focus of post-contrast enhancement is noted in the right cerebellum measuring approximately 7 x 6 x 5 mm image 900b 93 and 9 168 without definite correlates in the others series most likely represents an artifact there is otherwise no enhancing lesion to suggest intracranial metastasis an incidental note is made of a partially empty sella and a 5-mm pineal cyst image 3 12 the remaining brain parenchyma is only noteworthy for scattered punctate t2 flair hyperintense foci predominately in the right frontal subcortical white matter but also seen in the left frontal subcortical white matter non-specific the ventricles and sulci are normal in size and symmetric in configuration there is no shift of normally midline structures major vascular flow voids are normal no abnormal restricted diffusion is noted to suggest infarction there is no susceptibility artifact to suggest chronic or acute intracranial hemorrhage the visualized paranasal sinuses and mastoid air cells are clear
Impression:
1 no definite enhancing lesion to suggest brain metastasis followup as clinically indicated 3 scattered punctate white matter t2 flair hyperintense foci non-specific 4 incidental note of a partially empty sella and a 5 mm pineal cyst
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patient is status post resection of known lesions within the left parietal as well as the right parietal and temporal lobes there are post- surgical changes with foci of hemorrhage and air within the resection cavities and residual vasogenic edema post-operative pneumocephalus overlies the right frontal lobe within the surgical resection cavities there are areas of thickening and intense rim enhancement with a more nodular focus of enhancment in the right parietal resection cavity the rim enhancement is similar in pattern to the pre-operative mr studies while the nodular focus of enhancement was not evident on the pre-operative studies there are no additional foci of abnormal enhancement there is no shift of the normal midline structures the ventricles and sulci are normal in caliber
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1 enhancement along the margins of the resection cavities in the left parietal and right temporal parietal lobes similar to the pre- operative mri studies while this may represent post- surgical enhancement unusual given the time course residual tumor cannot be excluded 2 nodular focus of enhancement within the right resection cavity not seen on a preoperative study given its absence on the preoperative study this is less likely to represent residual tumor and may reflect enhancement related to postoperative trauma and or ischemia
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Findings:
there has been an interval increase of the enhancing nodular component in the left parietal lobe lesion surrounding the post-surgical cavity the cavity now measures 34 x 25 mm including the enhancing thick-walled rim from previously 19 x 16 mm the adjacent satellite 6-mm enhancing nodule superomedial to the resection site is also increased from the prior exam currently measuring 6 mm from previously 4 mm there is also a significant increase of the edema surrounding the postsurgical cavity which causes mass effect on the left parietal and frontal lobes with effacement of the sulci there is mass effect on the frontal and occipital horns of the left lateral ventricle and minimal shift of normally midline structures to the right by about 4 mm new compared to the prior exam there is restricted diffusion within the post-surgical cavity similar compared to ___ and difficult to interpret due to the residual postsurgical blood products in the cavity the recently treated 7 x 5 mm right temporal lobe enhancing lesion series 10 image 37 is not significantly changed from the prior exam the previously seen right parietal lesion measures 4 mm is unchanged the intracranial arterial flow voids are noted the paranasal sinuses mastoids and imaged orbits are unremarkable except for minimal mucosal thickening in the left maxillary sinus there are no suspicious bony or soft tissue lesions
Impression:
1 significant interval increase of the left parietal lobe leison - now has thick-walled nodular enhancing component surrounding the left parietal post-surgical cavity 2 signifiant interval increase of the cavity surrounding edema with increased associated mass effect 3 above findings can relate to radiation necrosis versus tumor progression correlate clinically for infection given the recent procedure follow up closely if no intervention is contemplated 4 unchanged right temporal and right parietal enhancing foci d w dr ___ by dr ___ on ___ at 4 30pm
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Findings:
post-surgical changes are again noted status post partial left temporal lobectomy with post-surgical changes in the left temporal left parietal and left frontal lobes there is encephalomalacia in these regions with ex vacuo dilatation t2 and flair hyperintensity are noted in the surrounding parenchyma stable in configuration since the prior study along the posterior margin of the resection cavity there is a nodular area of enhancement measuring 1 8 cm in maximal dimension not significantly changed since the prior study the cystic cavity within the lateral left temporal lobe is stable in appearance measuring 1 6 cm in maximal dimension similar to the prior study a second area of linear and nodular enhancement is noted in the posterior parietal lobe just superior to the tentorium slightly less apparent than on the prior examination with encephalomalacia of the parenchyma given the finding from prior studies this likely represents evolving post-surgical injury the ventricles sulci and cisterns are stable in size and configuration there is no midline shift there is no decreased diffusion to indicate an acute infarct there is mild mucosal thickening in the maxillary sinuses and mastoid air cells the orbits and soft tissues are otherwise intact
Impression:
1 post-surgical and post-treatment changes with a nodular enhancing focus along the posterior margin of the resection cavity given the lack of increased perfusion in this region on the prior study this likely represents radiation necrosis rather than residual or recurrent neoplasm however continued close-interval followup is recommended mr perfusion imaging should be considered at the time of followup imaging 2 evolving changes in the posterior parietal lobe likely representing post- surgical changes
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Findings:
re-demonstrated is the the resection cavity in the left frontal lobe with interval decrease of the associated blood products decrease of surrounding edema as well as resolution of the previously seen small subdural hematomas and pneumocephalus there is unchanged mild peripheral enhancement in the surgical cavity the previously seen nodular enhancement superomedial to the resection cavity is less pronounced on the current exam series 6 image 18 a small right temporal enhancing lesion 6 6x7 5mm is unchanged a tiny punctate focus in the right parietal lobe se 6 im 15 unchanged
Impression:
1 interval decrease of blood products nodular enhancement edema subdural hematoma and pneumocephalus associated with the left frontal lobe lesion resection 2 stable right temporal lobe and punctate right parietal lobe lesions
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Findings:
the patient is status post right craniotomy with resection of the enhancing right temporal mass curvilinear enhancement of the medial aspect of the surgical bed persists 17 12 at the most inferior aspect of the temporal lobe there is persistent nodular-shaped rim enhancement 17 8 and 6 18 the amount of right hemispheric edema is unchanged mass effect on the right lateral ventricle and effacement of the right hemispheric sulci are unchanged leftward shift of midline structures by 7 mm is unchanged there is no uncal herniation there are expected blood products in the surgical cavity with a fluid level on the t2-weighted images expected pneumocephalus overlies the right frontal lobe there is no diffusion restriction to indicate an acute infarct
Impression:
1 interval right craniotomy with resection of the right temporal mass 2 curvilinear enhancement of the medial surgical bed and persistent enhancement of the inferior right temporal lobe attention to these findings on followup studies is recommended 3 unchanged right hemispheric edema mass effect in the right lateral ventricle 7 mm leftward shift of midline structures and effacement of the right cerebral sulci
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there is partial interval resorption of the left parietal hematoma with short t1 effect on the flair sequences suggesting expected interval physiological evolution of blood products minimal interval resolution of flair signal changes surrounding the hematoma is demonstrated there are multiple patchy and confluent foci of periventricular and subcortical white matter changes on flair sequences suggesting moderate microangiopathic small vessel disease no new hemorrhage or evidence of acute infarction is demonstrated the right frontal sinus remains occluded by mucosal thickening and trapped secretions the ventricle dimensions are stable
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interval partial resorption of the left parietal hematoma and stable ventricular dimension without evidence of new hemorrhage or infarction no evidence of a mass lesion
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Findings:
left hemispheric t2 and flair hyperintensities with corresponding diffusion restriction predominantly involving the left posterior frontal and parietal lobes are consistent with acute to subacute infarct there is no intracranial hemorrhage or shift of midline structures the ventricles and cerebral sulci are unchanged in size and configuration basal cisterns are symmetric periventricular areas of t2 and flair signal hyperintensity likely represents sequela of chronic small vessel ischemic disease maxillary sinus mucosal thickening is again noted there is fluid within left mastoid air cells
Impression:
1 findings consistent with acute-to-early subacute mca distribution infarcts of the left hemisphere predominantly involving the left posterior frontal and parietal lobes the distribution suggests an embolic source 2 bilateral maxillary sinus disease
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Findings:
an area of volume loss involving the cortex of the right posterior parietal lobe with associated increased flair signal decreased t1 signal and corresponding gyriform enhancement there is no corresponding abnormality in the diffusion-weighted images this finding likely represents luxury perfusion of a late subacute infarct superimposed in an old infarct there is also an ill defined area of increased flair signal with enhancement in the left occipital lobe medially likely representing an additional late subacute infarct otherwise there are scattered t2 flair hyperintensities in the subcortical and periventricular white matter which are nonspecific but could be seen with chronic microangiopathic changes there is no evidence of hemorrhage note is made of a dva in the right posterior frontal lobe image 18 of sequence 10 the ventricles are normal in size there is no midline shift the flow voids are preserved there is mucosal thickening of the frontal ethmoid air cells the maxillary and sphenoid sinuses are clear the mastoid air cells are within normal limits
Impression:
1 area of encephalomalacia in the right parietal region with associated gyriform enhancement likely representing an acute on chronic and subacute infarct with luxury perfusion 2 additional left occipital late subacute infarct with luxury perfusion while less likely metastatic disease cannot be entirely excluded in this patient with known malignancy close followup is advised 3 there is no evidence of intracranial hemorrhage these findings were discussed with dr ___ ___ pager ___ at 1 20 pm on ___ 32 minutes after the discovery of the findings
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Findings:
there is no acute intracranial hemorrhage or acute infarct the previously demonstrated multiple areas of slow diffusion demonstrate multiple areas of flair signal abnormalities in keeping with old infarcts there is a background of moderate chronic small vessel microangiopathic disease as demonstrated by multiple t2 and flair hyperintensities in the supratentorial white matter the posterior fossa lesions appear resolved the ventricular dimensions and sulcal configuration are unchanged there is no intracranial mass edema or midline shift note is again made of a mucous retention cyst in the left maxillary sinus
Impression:
1 multiple small areas of flair white matter hyperintensities in keeping with old infarcts on a background of moderate microangiopathic small vessel disease no acute infarct or intracranial hemorrhage 2 stable appearances of mucous retention cyst in the left maxillary sinus
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Findings:
there has been no significant short interval change again there is no intracranial hemorrhage shift of normally midline structures or evidence of acute major vascular territorial infarct mild-to-moderate periventricular and subcortical white matter hypodensities consistent with chronic small vessel ischemic changes atherosclerotic calcifications involve the cavernous carotids and intracranial vertebral arteries bilaterally mild mucosal thickening involves the frontal and ethmoid air cells as well as the left maxillary and sphenoid sinuses the mastoid air cells appear well aerated a small right parietal subgaleal hematoma persists a smaller left parietal subgaleal hematoma is more conspicuous than on the recent prior
Impression:
no new intracranial hemorrhage
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