Clinical question: History of high-grade glioma status post multiple treatments, normal status post re-chemo/RT. Signs and symptoms: apraxia. Pre-and post-enhanced brain MRI:Examination demonstrates significant interval decreased size of the enhancing component of the large tumor in the left temporal lobe since prior study. The largest remaining focus of tumor enhancement measures at 24 x 43 mm in transaxial dimensions compared to prior study measurement of approximately 31 x 55-mm. This enhancement is immediately posterior to the surgical cavity in the left temporal lobe. The remaining tumor reaches the left lateral ventricle and with resultant slight bulge of tumor toward the intraventricular space. A very thin however irregular enhancement extends from posterior surgical cavity wall anteriorly. This pattern of enhancement also demonstrate interval improvement/decrease. There is also noticeable decreased in surrounding flair hyperintensity consistent with vasogenic edema since prior exam. Similar to prior study the surgical cavity is contiguous with the subarachnoid space and demonstrate an associated CSF signal intensity subdural space widening. The signal intensity of this collection follows CSF signal pattern. There is subtle interval decrease in extent of this collection since prior exam. There is however slight increased caliber of remaining extra-axial collection measuring approximately 15.6 mm compared to prior study measurement of 13. This collection lies subtle mass effect on the adjacent brain parenchyma is also noticeable interval increased size of left lateral ventricle likely secondary to underlying decreased tumor volume. Midline however is maintained.
1.Interval decreased size of enhancing component of tumor measuring at 24 x 43-mm compared to prior study measurement of 31 x 55-mm, interval decreased surrounding vasogenic edema and overall mass effect.2.Interval increased size of left lateral ventricle with maintained midline and likely secondary to decreased tumor volume and edema.