 Redemonstrated are enhancing lesions in the left medial temporal lobe and superior right cerebellar vermis. The enhancing lesion involving the left medial temporal lobe abutting the left cerebral peduncle and left optic tract is smaller measuring 5 x 10 mm (series 12, image 54) compared to 9 x 10 mm previously on the OSH MRI from 6/8/2016 and 10 x 13 on the brain MRI from 12/8/2015. The second enhancing lesion involving the right superior cerebellar vermis measures 10 x 11 mm, previously 10 x 12 mm on the OSH MRI from 6/8/2016 and 8 x 6 on the brain MRI from 12/8/2015 (when utilizing axial T1 postcontrast images, as this allows for more comparable measurements). The corresponding FLAIR signal abnormality in these regions is unchanged.There are several scattered foci of susceptibility compatible with hemosiderin staining and are unchanged. There are scattered periventricular and subcortical cerebral white matter T2/FLAIR hyperintensities which are nonspecific and stable. There is no diffusion abnormality. There is diffuse volume loss. The cisterns remain patent. There is no midline shift or mass effect. Normal flow-voids are demonstrated in the major intracranial vascular structures. There are changes related to right-sided parotidectomy which is only partially visualized. There is persistent asymmetric thickening of the post-geniculate segment of the right facial nerve on the delayed postcontrast images which is somewhat more continuous compared to the previous exam. There is fatty marrow replacement in the visualized marrow of the clivus and upper cervical spine, which is likely related to posttreatment changes.
1.Stable to decreased size of the left medial temporal lobe metastatic lesion.2.Right cerebellar vermian lesion stable since outside prior exam, but is remains slightly larger than more remote 12/2015 exam.3.Post surgical changes of parotidectomy which is incompletely evaluated with persistent more continuous enhancement of the post-geniculate portion of the right 7th nerve.4.Mild degree of unchanged chronic small vessel ischemic disease.