Bilateral lower extremity weakness and glioblastoma. There is interval development of confluent T2 hyperintensity in the anterior right temporal lobe with associated restricted diffusion. There is also interval development of diffuse gyriform intrinsic T1 hyperintensity, with superimposed faint patchy enhancement of the underlying white matter in the right temporal lobe. The peripherally enhancing lesion in the right peritrigonal white matter has nearly resolved. There is no definite elevated perfusion, without the limits of artifact on the perfusion sequence. There are scattered punctate foci of susceptibility effect within the right temporal lobe and left posterior midbrain. There is persistent confluent white matter T2 hyperintensity in the bilateral centrum semiovale, right more than left. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are unchanged. There is mild scattered paranasal sinus mucosal thickening.
1. Interval development of confluent T2 hyperintensity in the anterior right temporal lobe with associated restricted diffusion, may represent acute infarction and/or treatment effects rather than tumor progression. 2. Interval development of diffuse gyriform intrinsic T1 hyperintensity, with superimposed faint patchy enhancement of the underlying white matter in the right temporal lobe may represent subacute infarction and/or treatment effects rather than tumor progression. 3. The peripherally enhancing lesion in the right peritrigonal white matter has nearly resolved. 