24 years Female (DOB:2/16/1992)Reason: Eval tumor progression vs ischemia History: R sided numbness, changes in CT scan, ho anaplastic astrocytomaPROVIDER/ATTENDING NAME: MICHAEL ANDREW WARD SERVICES ANCILLARY There is redemonstration of a cystic appearing lesion centered in the left parietal lobe and measuring 31 x 32 mm axial dimensions and 45 x 27 mm sagittal dimensions. It is associated with diffusion restriction present in the adjacent periventricular white matter as well as the corpus callosum. There is vasogenic edema present within the left occipital lobe, parietal lobe and temporal lobe as well as external capsule and internal capsule and the posterior aspect of the frontal lobe. There is associated mass effect with compression of the left lateral ventricle. Since the prior exam the area of diffusion restriction appears to have enlarged. It now measures 36 x 14 mm axial dimensions were as it previously measured 26 x 12 mm axial dimensions. The vasogenic edema has also increased and extended compared to the prior exam.On susceptibility imaging there is redemonstration of numerous punctate foci of signal loss within the area of diffusion restriction but also in the thalami and white matter surrounding the lesion. Another focus of diffusion restriction is centered in the pons which on T2 and T1 imaging has a popcorn-like appearance. This measures approximately 8 mm axial dimensions.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.
1.Since the prior exam the area of diffusion restriction and the associated vasogenic edema located in the posterior aspect of the corpus callosum and in the deep white matter deep to the cystic cavity in the left parietal lobe has expanded. One possibility is that this is related to treatment effect. While another possibility in the context of antiangiogenic therapy may reflect tumor growth despite lack of contrast enhancement.2.There is redemonstration of a cerebral cavernous malformation located in the pons