History of tuberous sclerosis and seizures with increased frequency of auras for follow-up. There is interval development of a 7 mm enhancing lesion just inferior to the right superior frontal sulcus with mild associated edema.There is a stable CSF signal intensity fluid collection in the prior right parietooccipital resection, measuring 66 x 20 x 47 mm (AP x TR x CC), previously 66 x 22 x 47 mm. There is unchanged associated T2/FLAIR signal abnormality around the postoperative resection margin, likely gliosis and encephalomalacia. There is unchanged prominence of the ventricles and sulci diffusely indicative of global volume loss as well as unchanged prominence in the right atrium of the lateral ventricle, likely due to focal ex vacuo dilatation. There is no midline shift. There are multiple scattered foci of susceptibility in the parenchyma and around the previous resection, likely due to old hemosiderin deposition from prior surgery. Stable patchy high signal in the frontal lobe deep white matter, slightly greater on the right. No intracranial hemorrhage is identified. Normal vascular flow voids are present in the major intracranial vascular structures.
1. A new 7 mm enhancing lesion is identified just inferior to the right superior frontal sulcus with mild associated parenchymal edema. This lesion would be atypical for any of the usual CNS stigmata of tuberous sclerosis. Consideration should be given to the possibility of either a primary brain neoplasm or a metastatic lesion. Patients with tuberous sclerosis are at increased risk for the development of certain abdominal malignancies, and as such, screening of the chest abdomen and pelvis should be considered.2. Stable appearance of the right parietal postoperative resection cavity with surrounding gliosis and encephalomalacia. No mass effect or midline shift. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.