 Again seen is an infiltrating mass involving the hypothalamus extending into the optic chiasm, left greater than right. Mass measures approximately 17 x 20 x 13 mm and unchanged allowing for differences in measurement technique. Posteriorly mass abuts the mamillary bodies. Pituitary gland and infundibulum which are more inferior appear grossly unremarkable. Again noted is focal enlargement of the left prechiasmatic optic nerve likely reflecting tumor involvement, coronal STIR series 1201 images, and is adjacent to/contiguous with the larger mass more posterior superiorly. No findings to suggest interval enlargement or new enhancement.Images of the remainder of the brain again demonstrate patchy foci of T2 hyperintensity within the basal ganglia, thalami, cerebral peduncles, brainstem, cerebellum as well as within the left amygdala/medial temporal lobe where there is also mild expansion without enhancement. Again seen is a tiny linear focus of enhancement within the right precentral gyrus with susceptibility most likely representing an incidental small developmental venous anomaly or capillary telangiectasia. There is no evidence of acute infarct or hemorrhage. The ventricles and basal cisterns are normal 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 grossly unremarkable.
1.Compared to 5/22/2015, there is no significant change in size of glioma involving the hypothalamus/optic chiasm and extending mildly to involve the left prechiasmatic optic nerve.2.Additional stigmata of NF 1 including numerous supratentorial and infratentorial foci of T2/FLAIR signal abnormality" are unchanged.3.The left medial temporal lobe/amygdala focus of signal abnormality with mild expansion also remains unchanged. Suggest attention on follow-up for possibility of an additional focus of glial neoplasm.