61 years Male (DOB:4/12/1954)Reason: Brain tumor History: SeizuresPROVIDER/ATTENDING NAME: CHRISTOPHER M GOMEZ CHRISTOPHER M GOMEZ The CSF spaces are appropriate for the patient's stated age with no midline shift. There is redemonstration of a 23 x 14 mm axial dimension right parafalcine mass located adjacent to the right cingulate gyrus. There is a cortical venous structure and an ACA branch interposed between the mass and the falx suggesting this mass is intra-axial. There is associated dural and leptomeningeal enhancement. There is adjacent vasogenic edema. There is redemonstration of leptomeningeal enhancement along the right cingulate sulcus adjacent to this above described mass. It is significantly larger compared to the December 2012 exam when it measured approximately 8 mm.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.
There is a mass present involving the right cingulate gyrus associated with some leptomeningeal enhancement. This mass demonstrated significant growth since December suggesting it is an aggressive/higher grade lesion. Differential considerations include primary brain tumor, metastatic disease, lymphoma, granuloma and infection. Given the leptomeningeal reaction this brings to mind lesions with a tendency towards leptomeningeal reaction such as pleomorphic xanthoastrocytoma, granuloma and lymphoma.