Vertigo, history of stem cell transplantation. There are multifocal restricted diffusion lesions involving bilateral periventricular white matter, thickening of interventricular septum, inferior aspect of caudate nucleus head, pineal gland and mainly bilateral cerebellar white matter as well as right superior, bilateral middle and right inferior cerebellar peduncles. On Gad enhancement, those lesions show nodular and patchy enhancement on periventricular lesions, and mainly patchy enhancement on cerebellar lesions. Gradient echo images show susceptibility artifacts for right cerebellar lesion indicating possible central hemorrhagic conversion.Considering the patient's history of stem cell transplantation, these lesions could represent post transplant lymphoproliferative disease, infiltrative tumours such as CNS lymphoma, lympho-infiltrative vasculitis with possible associated with acute ischemic infarctions and hemorrhagic transformation especially right cerebellar lesion. However, the possibilities of infectious origin cannot be excluded.Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.Internal Auditory Canal MRIAgain bilateral cerebellar white matter lesions and bilateral middle cerebellar peduncle lesions were seen.However, the inner ear structures, cochlea, vestibule, semicircular labyrinth are normal. The internal auditory canals are normal with delineation of the facial, cochlear and vestibular nerves. No evidence of signal abnormality, mass or abnormal enhancement is noted.
Multifocal supra and infratentorial nodular and patchy enhancing lesions as described above. Diagnostic possibilities include PTLD, CNS lymphoma, lympho- infiltrative vasculitis with acute ischemic infarctions and hemorrhagic conversion on the right cerebellar lesion as described above.Discussed with Dr. Kline at the time of this dictation. 