Neurosarcoid: cognitive decline. There is decreased diffuse leptomeningeal enhancement, nodular thickening and enhancement of the pituitary infundibulum and hypothalamus. However, the diffuse patchy bilateral cerebral white matter T2 hyperintensity has increased in extent. There is also prominence of the bilateral cerebral hemisphere medullary veins diffusely. In addition, there is gyriform susceptibility effect and T1 hyperintensity, as well as T2 hypointense white matter in the bilateral occipital lobes. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. There is unchanged diffuse heterogeneity of the calvarium. There are postoperative findings to right transfrontal biopsy. The orbits are grossly unremarkable.
1. Interval progression of encephalopathy, but decreased leptomeningeal disease, with possible stigmata of superimposed seizure activity and subarachnoid hemorrhage in the occipital lobes that likely represent manifestations of neurosarcoidosis, although a concurrent infectious process is also a consideration.2. A minor contrast extravasation occurred at the right forearm IV site without clinically significant consequences.