Enhancing lesion. Expressive language problem. There is no evidence of intracranial hemorrhage or acute infarct. There is increased leptomeningeal enhancement with punctate areas of restricted diffusion and possible minimal cortical involvement, as well as sulcal T2 hyperintensity and susceptibility effect in the left frontal lobe, including the precentral sulcus, and to a lesser extent the left temporal lobe. There are increased foci of cerebral white matter T2 hyperintensity, particularly in the left frontal and temporal lobes. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are unremarkable. There are bilateral lens implants.
1. Interval increased leptomeningeal enhancement with possible minimal cortical involvement and sulcal T2 hyperintensity in the left frontal lobe, and to a lesser extent the left temporal lobe. Differential considerations neoplastic, vascular, or perhaps granulomatous conditions.2. Interval increased foci of cerebral white matter T2 hyperintensity is nonspecific, but may represent a vasculitis or demyelinating process, for example.Discussed with Dr. Brorson at 4PM on 1/14/15.