19 years Male (DOB:2/18/1997)Reason: 3T Scanner, CCM Protocol qsm/permeability if possible, no contrast per patient's request History: know CCM please evaluate lesions for changesPROVIDER/ATTENDING NAME: ISSAM A. AWAD ISSAM A. AWAD There is redemonstration of a hemorrhagic focus centered in the right medial temporal lobe and extending into the inferior aspect of the insular cortex and abutting the temporal horn right lateral ventricle. It has a heterogeneous appearance centrally on T2 imaging and dark ring around it and measures approximately 10 mm in diameter. Compared to the prior exam from 7/28/2014 it is similar in size.There are additional hemorrhagic foci with low signal rings compatible with the cerebral cavernous malformations. One is located in the right parietal lobe currently measuring 13 x 19 mm sagittal dimensions and previously measuring similar dimensions. Another is located in the right parietal lobe also not significantly changed and measuring approximately 9 mm. Yet another one is located adjacent to the left lateral ventricle at the junction of the trigone with the body of the left lateral ventricle measuring 9 mm and also is unchanged.Patient is status post left temporal lobe surgery. A portion of the left temporal lobe has been removed. The appearance of the surgical site remains stable. There is a small heterogeneous focus present along the medial left temporal lobe adjacent to the anterior tip of the temporal horn measuring approximately 5 mm in size. It is not clear whether this represents postsurgical effect or residual cavernoma without the preoperative exam.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.
1.Multiple lesions in the brain parenchyma are compatible with cerebral cavernous malformations and appear relatively stable.2.Status post left temporal lobe surgery. Differentiation of the postoperative change and residual cavernoma is not entirely clear on this exam. It is unchanged since the prior exams. Comparison to the preoperative exam may be helpful.