Reason: enlargement of his lateral and third ventricles in the setting of aqueduct stenosis, caused by a small glioma History: yearly follow up, new headaches. There is again seen a subtle nonenhancing exophytic T2 hyperintense lesion in the left periaqueductal region measuring 5 mm which is similar in appearance to prior exams. Dilatation of the lateral and third ventricles is slightly increased. Minimal periventricular T2 hyperintensity is unchanged. There is no evidence of intracranial hemorrhage or acute infarct. There is no abnormal intracranial enhancement, although please note that thin section 3-D T1 post contrast images were inadvertently not obtained. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.
1.Subcentimeter lesion in the left periaqueductal region is unchanged. Future follow-up should include thin section postcontrast images for a complete evaluation, as well as thin section T2-weighted imaging with the area of the lesion. This could be achieved with a "midline tumor" protocol.2.Aqueduct narrowing with associated obstructive hydrocephalus, subtly increased from the prior exam.