Evaluate for brainstem infarct. Confusion, aphasia, and bilateral leg weakness, all persistent since seizure in October. Per chart patient has history of left frontal oligodendroglioma resected in 1983. BrainDiffusion images are slightly motion degraded however no evidence of acute infarct is appreciated. Again seen is evidence of left frontal craniotomy and extensive encephalomalacia in the left frontal lobe, compatible with history of prior tumor resection. There is also encephalomalacia involving the left basal ganglia which appears to be present on remote study from 2003. There is moderate global parenchymal volume loss. There is moderate degree of confluent T2/flair hyperintensity involving the bilateral periventricular and subcortical white matter. More focal area of FLAIR hyperintensity and volume loss is noted within the left occipital lobe involving the cuneus compatible with chronic infarct. Symmetric T2 flair hyperintensity is also noted within the central pons bilaterally. T2/flair hyperintensity and volume loss along the left midbrain and pons is compatible with Wallerian degeneration.No intracranial mass or mass-effect is appreciated although evaluation for small lesions is limited due to motion artifact and absence of gadolinium. Major flow-voids are preserved. Paranasal sinuses and mastoid cells are clear. Bone marrow signal and extracranial soft tissues are grossly unremarkable.Cervical SpineExtensive motion artifact severely limits evaluation for cord signal abnormality. Multiple apparent T2 hyperintense foci in the cervical cord may be artifactual. Mild degenerative changes are seen without evidence of extrinsic cord compression. Vertebral body heights and alignment are within normal limits.Lumbar SpineVertebral body heights in the lumbar spine are within normal limits. There is mild retrolisthesis of L4 on L5 and minimal retrolisthesis of L5 on S1. Mild disk bulges are seen without significant spinal canal stenosis at any level in the lumbar spine. Mild bilateral neural foramina stenosis at L4-L5 and mild to moderate bilateral neural foramina stenosis at L5-S1 is seen. T2 hyperintensity at the L5-S1 disk this may be on a degenerative basis. No surrounding fluid collections to suggest abscess.Partially imaged is a multiloculated cystic mass in the pelvis, possibly adnexal in origin. Mass measures more than 5 cm in the AP dimension.
1. Motion artifact limits evaluation; however, no evidence of acute infarct is seen.2. Encephalomalacia in the left frontal lobe and basal ganglia compatible with remote history of left frontal tumor resection. No intracranial mass or mass-effect is appreciated although evaluation for small lesions is limited due to motion artifact and absence of gadolinium. 3. Mild encephalomalacia in the left occipital lobe may be related to small chronic infarct. Moderate global parenchymal volume loss. 4. Confluent T2/FLAIR hyperintensity in the bilateral periventricular and subcortical white matter as well as pons is nonspecific but compatible with moderate chronic small vessel ischemic disease. Evidence of Wallerian degeneration along the left corticospinal tract in the brainstem.5. Examination is inadequate to evaluate for cord signal abnormality in the cervical spine. No evidence of extrinsic cord compression.6. No significant spinal canal stenosis in the lumbar spine. There are degenerative changes with mild to moderate neural foraminal stenosis at L5-S1 which may be impinging on the L5 nerve roots.7. Multiloculated cystic mass in the pelvis measuring at least 5 cm in the AP dimension. Mass is incomplete visualized but may be adnexal in origin. Recommend dedicated imaging with ultrasound or CT. 