Diagnosis: Malignant neoplasm of brain, unspecifiedClinical question: Eval AA. On CCNU+Avastin.Signs and Symptoms: AAComments: AA on Avastin+CCNU. | The CSF spaces are appropriate for the patient's stated age with no midline shift. The patient is status post left frontal burr hole placement. A track of susceptibility effect courses from the burr hole to the left thalamic lesion suggesting this could be related to prior stereotactic biopsy.There is a left posterior thalamic lesion present with T1 hyperintensity and a focus of susceptibility effect which is stable in appearance when compared to the previous exam. It is associated with ill-defined enhancement which has not significantly changed since previous exam nor the June exam.There is a nonenhancing focus present in the left centrum semiovale with T2 and FLAIR signal hyperintensity which is stable compared to the prior exam from November 6, however, it has mildly progressed since 6/5/2015 and especially since 5/19/2014.A small focus of patchy enhancement is associated T2 and FLAIR signal hyperintensity and is adjacent to the occipital horn of left lateral ventricle. It is stable since the prior exam. It is associated with a punctate focus of susceptibility effect.An ill-defined focus is present along the posterior aspect of the left temporal lobe which was not present in June 2015 and was present on November 2015 appears slightly larger on the current exam. It encompasses an area measuring approximately 30 x 18 mm axial dimensions and demonstrates some gyral enhancement.There is a new ill-defined focus of T2 and FLAIR signal hyperintensity present along the posterior and medial aspect of the right superior frontal gyrus which is associated with a small amount of contrast enhancement.A small lesion in the left paracentral lobule subcortical white matter associated with contrast enhancement is unchanged since the prior 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.There are multiple ill-defined lesions scattered in both hemispheres of the brain but predominantly in the left hemisphere some which are associated with ill-defined contrast enhancement and some of which are larger on the current exam and at least one of which is new since the prior exam. Overall there appears to be continued progression. Stereotactic biopsy of the left thalamus demonstrated anaplastic astrocytoma. Because the other lesions have similar imaging characteristics to the thalamic lesion, it is thus reasonable to suggest that these represent a multifocal astrocytic glioma. These lesions are not associated with edema and similar to literature reported recurrent lesions which have been reported to be resistant to Avastin treatment.