Clinical question: Evaluate for bleed. Signs and symptoms: Altered mental status. Nonenhanced head CT:Examination demonstrates multiple patchy areas of low attenuation in bilateral cerebral hemispheres. Some regions demonstrate mass effect evidence by effacement of adjacent cortical sulci. There is also a focus of low-attenuation with well-demarcated margin in the right mid temporal lobe that has the appearance of a cyst. There is no evidence of hemorrhage as clinically is questioned. The ventricular system are within normal range of size and not significantly changed since prior exam. Areas of low attenuation described above correspond with areas of peritumoral vasogenic edema noted on prior MRI examination from 2 -- 22 -- 11. There is however suggestion of interval increase in the amount of edema which may indicate further progression of disease. Recommend follow-up with an infused head CT or unenhanced MRI of brain. No evidence of abnormality of posterior fossa and stable since prior exam.
Multiple large areas of peritumoral vasogenic edema with subtle associated mass-effect and with interval worsening since prior MRI examination from 2 -- 22 -- 11.