PNET with neuraxis dissemination; now status post chemoradiation in November 2015 and hemiparesis. Brain: There is a large heterogeneous mass in the right frontoparietal region that is not significantly changed in size. However, there is extensive supratentorial and infratentorial leptomeningeal enhancement. There is also new nodularity and diffuse enhancement along the margins of the ventricles, as well as intraventricular debris, perhaps with a hemorrhagic component. There increased ventricular dilatation. There are bilateral cerebral convexity subdural fluid collections, left larger than right. There is no evidence of acute infarct. Spine: There is extensive diffuse leptomeningeal enhancement throughout the spinal neuraxis. There are also multiple foci of T2 hyperintensity and swelling within the spinal cord. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant extrinsic spinal canal stenosis.
1. Progression leptomeningeal disease throughout the neuraxis and intraventricular disease, which is compatible with cerebrospinal fluid dissemination of tumor, with associated edema in multiple areas of the spinal cord and superimposed intraventricular hemorrhage. The right frontoparietal PNET is otherwise unchanged.2. Small bilateral cerebral convexity subdural fluid collections without significant mass effect.