 Brain MRI:Redemonstrated is diffuse cortical thickening and T2/FLAIR hyperintensity involving the right frontal lobe including the right precentral gyrus, most conspicuous along the right parasylvian cortex and laterally along the right frontal lobe. There is also involvement of the right insula, the right cingulate gyrus, right mesial temporal lobe, and the right thalamus. There is also mild possible increased signal within the right basal ganglia and caudate without enlargement. There is no associated diffusion restriction or associated enhancement. There is associated subtle right cerebral sulcal effacement in areas of abnormality. There are new expected changes secondary to right frontal approach biopsy with a tract extending to the right thalamus.The ventricles and sulci are otherwise within normal limits. The cisterns remain patent. There is no midline shift. No extra-axial fluid collection is identified. Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. Brain perfusion and spectroscopy:Pertinent spectroscopic peak heights are as follows:Thalami:*NAA 0.090 right, 0.107 left*Choline 0.092 right, 0.066 left*Creatine 0.121 right, 0.088 leftInsula:*NAA 0.124 right, 0.160 left*Choline 0.134 right, 0.087 left*Creatine 0.171 right, 0.125 leftThe in NAA/Cr ratio is distinctly abnormal in the right thalamus and insula. However, the Choline/Cr ratio is not. However, when comparing metabolite peak heights on the involved right interrogated sites compared to left contralateral controls, there is an overall increase in both right-sided choline voxels suggesting an increase in cellular membrane density. Additionally, the creatine "standard" is elevated within both right-sided voxels, suggesting an increase in overall right-sided interrogated metabolic rate, which would thus skew ratio analysis due to variability of this internal control. There are no peaks demonstrating lactate or lipid. The overall metabolic profile appears the same for both the interrogated right thalamus and right insula.Corrected rCBV demonstrates a very subtle and diffuse increase within the involved right sided hemispheric structures, primarily demonstrated within the adjacent white matter rather than the thickened gyri.Complete spine MRI:Alignment is normal. The marrow signal is benign. The spinal cord is normal in signal without abnormal enhancement. The cervicomedullary junction is normal. Redemonstrated is diffuse The cerebellar tonsils are in normal position. The visualized paraspinal contents are unremarkable. There are no osseous dysplasias or stenoses.
1.Redemonstrated is diffuse cortical thickening and T2/FLAIR hyperintensity involving the right frontal lobe including the right precentral gyrus, most conspicuous along the right parasylvian cortex and laterally along the right frontal lobe. There is also involvement of the right insula, the right cingulate gyrus, right mesial temporal lobe, and the right thalamus. There is also mild possible increased signal within the right basal ganglia and caudate without enlargement. There is no associated diffusion restriction or associated enhancement. There is associated subtle right cerebral sulcal effacement in areas of abnormality. These findings are overall stable in appearance. However, there are new expected changes secondary to right frontal approach biopsy with a tract extending to the right thalamus.2.Perfusion and spectroscopic analysis suggests elevated metabolism and an increase in membrane density within interrogated voxels of both the right thalamus and right insula. The overall metabolic profile appears the same for both the interrogated right thalamus and right insula locations.3.Negative complete spine with contrast. Specifically, there is no abnormal enhancement of intrathecal contents.