Female, 57 years old, with von Hippel-Lindau and pre-existing hemangioblastoma of the cerebellum. Evaluate for growth and new lesions. Brain:A punctate focus of enhancement within the left cerebellar tonsil may be slightly more conspicuous than on the prior examination, though it still measures no more than 2 mm in size and does not produce any edema in the surrounding parenchyma. No additional enhancing lesions are seen. No areas of focal signal abnormality or restricted diffusion are detected. There is no edema or mass effect. No evidence of intracranial hemorrhage or any abnormal extra axial fluid collection is seen. Ventricular size and morphology are within normal limits.Spine:The spinal cord, conus and nerve roots of the cauda equina demonstrate normal morphology and signal characteristics. Small foci of enhancement along the cauda equina are nonspecific and may simply represent normal vessels. No definite masslike lesions are seen.Mild reversal of the cervical lordosis is seen. Otherwise, spinal alignment is anatomic. Vertebral body heights are preserved. Spinal numbering reflects the presence of 13 thoracic and 5 lumbar type vertebrae. Evidence of prior posterior element surgery, perhaps reflecting partial laminectomy, is seen at L3-4 and L4-5. No pathologic marrow replacement is noted. Mild degenerative endplate signal changes are seen in the cervical spine at multiple levels and in the lumbar spine at L4-5.Mild posterior disc-osteophyte complex formation is seen at C4-5 through C7-T1 without high-grade spinal stenosis, similar to the prior examination. Mild foraminal narrowing is seen on the left at C5-6 and bilaterally at C6-7. Scattered small disc protrusions are evident in the thoracic spine without significant spinal canal or foraminal compromise. The lumbar intervertebral discs are fairly well preserved with the exception of L4-5 where there is loss of disc height and disc bulging with osteophyte formation. No significant spinal canal stenosis is seen. However, the L4-5 neural foramina are mildly narrowed, similar to prior.
1.A punctate focus of enhancement within the left cerebellar tonsil is slightly more conspicuous though still only measures 2 mm in size. This perceived difference could potentially be technical in nature. The finding is nonspecific, but given the patient's history, a small hemangioblastoma remains in the differential.2.No definite additional hemangioblastomas are seen in the brain or spine. Scattered tiny foci of enhancement within the cauda equina are nonspecific and could simply represent vascular structures.3.Mild degenerative findings in the spine show no significant interval change.