Clinical question: Evaluate for change in enhancing lesion. Patient is now on high dose of steroids. History of grade 2 meningioma. New visual symptoms. Signs and symptoms: As above. Pre and post enhanced brain MRI:Examination demonstrates noticeable interval decrease in vasogenic edema in the left anterior frontal since prior exam with resultant better visualization of cortical sulci and the subarachnoid space.There is also significant interval decrease in the extent of patchy enhancement of left frontal cortex and periventricular white matter of the frontal horn of left lateral ventricle since prior exam.A previously noted uniformly enhancing masslike lesion along the floor of the left anterior cranial fossa with resultant subtle elevation of the left frontal lobe and significant bulge into the apex of the left orbit is again noted. This mass demonstrate interval decreased enhancement and with a new central focus of hypoenhancement . This lesion however demonstrate no convincing evidence of change in its size, extent or overall mass effect on the left orbital apex. On coronal T2 weighted images the mass measures at least 11.5 mm in cranial caudad axis which is nearly identical to prior exam.Extra-axial enhancing lesion along the lateral aspect of the middle cranial fossa anteriorly is again identified without evidence of change in its size and measuring approximately 20 x 12 mm in transaxial dimensions (axial post enhanced series 11 image 23). There is however subtle interval decrease in intensity of enhancement since prior study.
1.No diffusion-weighted abnormalities.2.Interval significant decreased vasogenic edema in the left frontal lobe since prior study.3.Interval significant decrease in enhancement of the left frontal cortex and left frontal periventricular white matter.4.Extra-axial mass along the floor of left anterior cranial fossa without significant change in its size or mass effect on the apex of the orbit however it demonstrate decreased enhancement as detailed/measured about. This mass similar to prior exam demonstrate extension into the left anterior aspect of the cavernous sinus.5.Decreased enhancement however without change in the size of a left lateral anterior middle cranial fossa mass since prior exam.