Reason: s/p SRS for resected lesion History: None. There are postoperative changes of left parietal tumor resection with foci of susceptibility within the cavity suggesting old hemorrhage. Enhancement within the cavity is significantly increased measuring 3.0 x 2.2 cm (1 201/119, previously 2.4 x 1.0 cm. In addition, there is increased surrounding edema with T2 signal extending along the splenium of the corpus callosum, posterior limb of the left internal capsule, and into the left temporal lobe. There is an enhancing dural based lesion along the left temporal lobe which is significantly increased in size measuring 3.1 x 2.3 cm (1201/70), previously 0.7 x 0.6 cm. The lesion exhibits mass effect with effacement of the frontal horn of the left lateral ventricle and mild 3 mm left to right midline shift. Two smaller dural based enhancing lesions along the left occipital lobe inferior to the resection cavity are new from the prior exam.Left frontal and parietal subdural collections seen on the prior exam have resolved. Subependymal nodules at the foramina of Monro are unchanged. There is no evidence of intracranial hemorrhage or acute infarct. The major cerebral flow voids are intact. The orbits and paranasal sinuses are grossly unremarkable. There is a disconjugate gaze.
1.Significantly increased enhancement within the resection cavity. Given the timing of prior radiation, differential diagnosis includes radiation necrosis or recurrent tumor.2.There is a large dural based left temporal lesion which has significantly increased in size, likely progressive metastatic disease. In retrospect, this was present on the prior exam, although much smaller. There are additional smaller dural based lesions inferior to the resection cavity which are new, also likely metastases.3.Subependymal nodules are unchanged and likely related to patient's known tuberous sclerosis.