56 years Male (DOB:12/9/1959)Reason: follow up of CNS nocardiosis History: asymptomatic at present; have changed to an all oral regimen since last examPROVIDER/ATTENDING NAME: KATHLEEN M. MULLANE KATHLEEN M. MULLANE There is a lesion in the right occipital lobe redemonstrated which is susceptibility effect and some signal hyperintensity on the diffusion-weighted imaging associated with diffusion restriction and surrounding pattern of vasogenic edema on T2 and FLAIR imaging. This appears to be stable compared to the previous exam additional punctate foci of susceptibility are redemonstrated in the right periventricular white matter and in the left frontal lobe adjacent to the left superior frontal sulcus..There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. There are bilateral staphylomas present.Within the nasal cavity there is redemonstration of a opacity involving the left superior nasal concha which was also present on prior exams.
1.There is redemonstration of a right occipital lobe lesion associated with edema and blood products which remains stable. This is somewhat nonspecific. One possibility is that may represent an infection. Nocardiosis may have this appearance though this appearance is not specific.2.There are microhemorrhages redemonstrated in the right centrum semiovale and left frontal lobe which are also stable.3.A lesion in the left nasal cavity extending towards the adjacent ethmoid air cells is also stable. Please correlate with clinical evaluation. A CT scan may help evaluate for underlying bone infiltration.4.Bilateral ocular staphylomas are redemonstrated.