Clinical question: History of meningioma status post resection. Signs and symptoms: Surveillance. Pre-and post-enhanced brain MRI:Negative diffusion weighted series.Examination demonstrates chronic postoperative changes upper left parietal craniotomy. There is a focus of encephalomalacia and gliosis under the craniotomy flap.Post enhanced images demonstrate minimal enhancing epidural thickening at the craniotomy site however without convincing evidence of residual or recurrence of tumor. Further follow-up however these needed.Multiple periventricular and subcortical foci of flair hyperintensity without interval change since prior exam are identified. The findings are nonspecific however possibilities of demyelinating disease and small vessel ischemic strokes should be considered. Some of the lesions have a perpendicular course to the ventricular system which could represent demyelinating plaques. Correlate with history and risk factors.
1.Chronic changes of left parietal craniotomy without evidence of residual or recurrent soft tumor. Further follow-up is recommended.2.Negative diffusion weighted series.3.Stable multiple foci of flair hyperintensity in the periventricular and subcortical white matter without enhancement. Some of the lesions appear perpendicular to the ventricular wall and could represent demyelinating disease. Small vessel ischemic strokes cannot be entirely excluded