45 years Female (DOB:10/4/1970)Reason: s/p resection brain mat a long time ago. PLease evaluate for progression in brainstem History: WobblyPROVIDER/ATTENDING NAME: STEVEN J. CHMURA STEVEN J. CHMURA There is redemonstration of enhancing lesions within the brain parenchyma. One in the left middle frontal gyrus posteriorly measures 7 mm and previously measured approximately the same. One along the left inferior frontal gyrus measures 6 mm and previously measured similar dimensions. One in the right centrum semiovale measures 5 mm and previously measured the same. One in the medial aspect of the right occipital lobe measures 7 mm and previously measured approximately the same though it enhances less on the current exam. One in the left cerebellar hemisphere measures 15 mm and is stable. One in the pons measures 10 x 13 mm and is stable. One in the left cerebellar hemisphere inferiorly measures 10 mm and previously measured the sameThe patient status post left frontal craniotomy and suboccipital craniotomy. There is a enhancement along the margins of the left frontal craniotomy site the calvarium and adjacent soft tissues. This most likely postoperative in nature. Within the suboccipital craniotomy site there are fluid collections present within the subcutaneous tissues which appear to be more organized on the current exam versus the prior.There is no abnormal enhancing lesion identified in the left frontal lobe at the surgical site. Previously within the posterior fossa at the surgical site there are 2 large lesions present. One was at the left cerebellar hemisphere inferiorly and the other one was medial aspect of the right cerebellar hemisphere. Comparing with the preoperative exam from 5/2/2016 there is a there are small foci of nodular enhancement present at the surgical margins which are more apparent on the current exam than on the prior. Small nodule is present along the left inferior cerebellum at the surgical margin which is not clearly delineated on the prior exam and was possibly obscured by associated findings. Another focus of nodular enhancement is present along the inferior aspect of the right cerebellar hemisphere at the surgical margin measuring 9 x 6 mm. There is also redemonstration of a enhancement along the surface of the cerebellum along the posterior fossa surgical sites which is likely postoperative in nature.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.
1.There are multiple lesions scattered within the brain parenchyma including supratentorial and infratentorial brain compatible with metastases. These are stable since the examination from May 4.2.The patient is status post suboccipital craniotomy for tumor removal/debulking. Postoperative changes include fluid collections at the surgical site. This could represent seroma or CSF leak. At the surgical margins within the cerebellum there are nodules in the enhancement which are suggestive of a small bits of residual or recurrent neoplasm.3.The patient is status post left frontal lobe surgery. There is no evidence for local recurrence.