Female, 33 years old, with history of brainstem cavernoma, severe motor deficits after craniotomy. Six month follow-up. Evidence of left temporal craniectomy is again seen. Distortion and encephalomalacia within the adjacent left temporal parenchyma has become more prominent. However, no evidence of parenchymal edema is seen. Rather, there is ex vacuo dilatation of the left temporal and occipital horns. The parenchyma adjacent to the craniectomy site herniates mildly through the craniectomy defect.A partially resected cavernoma within the left dorsal brainstem at the junction of the midbrain and pons is redemonstrated. The lesion is stable to slightly smaller in size with some interval change in the pattern of internal T1 hyperintensity. No evidence of significant surrounding parenchymal edema is seen. No findings to suggest continued interval bleeding are noted.A small focus of encephalomalacia within the left dentate nucleus is unchanged from prior. Bilateral T2 hyperintensity and swelling of the inferior olivary nuclei is unchanged as well.No new intracranial lesions are seen. A small venous structure is redemonstrated running along the right aspect of the residual cavernoma. No other pathologic enhancing lesions are seen. The ventricular system is stable in size and morphology.
1.A partially resected left dorsal brainstem cavernoma is stable to slightly reduced in size. No evidence of interval bleeding is seen, and there is no edema in the surrounding parenchyma.2.Encephalomalacia has progressed at the left temporal craniectomy site.3.Findings compatible with hypertrophic olivary degeneration are unchanged.