70 years, Female, Reason: evaluate for ?subacute ischemia, change in SDH or meningioma History: AMS. MR BRAIN: Since the prior brain MRI from 5/20/2016, there has been development of area of T2/FLAIR hyperintensity involving the left occipital lobe. There is T1 shortening with susceptibility effect and enhancement in this region. Findings are most compatible with a hemorrhagic infarct in the left PCA territory. There is no evidence of acute infarct. Again seen is a small subdural collection along the left frontal convexity which is decreased in size from approximately 14 mm to 5 mm; residual subdural collection demonstrates no significant mass effect.Again seen is evidence of multiple prior bilateral craniotomies. There are extra-axial enhancing masses along the frontal convexities bilaterally consistent with meningiomas. The posterior high right frontal convexity mass measures 23 x 26 x 21 mm which is unchanged. The anterior left frontal convexity mass measures 22 x 20 x 17 mm which is also unchanged allowing for slight differences in measurement technique. Both of these masses are invading the superior sagittal sinus. Mild nodularity elsewhere along the left convexity is also related to small meningiomas and unchanged. More diffuse dural enhancement and thickening also not significantly changed.There is plaque-like dural thickening along the left pterion measuring 8 to 9 mm in thickness likely representing en plaque meningioma. Similar en plaque meningioma is evident along the right inferior cerebellar hemisphere measuring 6 mm in thickness and also similar to prior. There is feathery enhancement in this region which may be reflective parenchymal invasion and/or postradiation change. The right cerebellum is atrophic and demonstrates increased T2 signal as before which may reflect posttreatment change. Hemosiderin staining associated with right frontal lobe encephalomalacia again noted. There is also a small area of encephalomalacia with susceptibility involving the right temporal lobe. Small left basal ganglia infarct with chronic hemorrhage also noted. Additional small cortical infarct is noted involving the left postcentral gyrus. There are multiple foci of susceptibility compatible with chronic microhemorrhage throughout the brain as before. A rounded 7 mm lesion with susceptibility in the right inferior frontal lobe is also unchanged and may represent a cavernous malformation. No midline shift or herniation. There is ex vacuo dilatation of the frontal horns related to encephalomalacia. No hydrocephalus. Unchanged empty sella which may be postsurgical.MR venogram: There is invasion with occlusion of the anterior and mid aspects of the superior sagittal sinus by the bilateral frontal meningiomas. The posterior superior sagittal sinus remains patent as does the remainder of the venous system.
1. Compared to 5/20/2016, there has been development of a hemorrhagic infarct in the left occipital lobe which appears subacute.2. Left sided subdural collection has decreased in size.3. No significant change in multiple meningiomas.4. Multiple foci of chronic hemorrhage in the brain, some of which are related to areas of encephalomalacia and may reflect prior hemorrhagic infarcts and/or postsurgical change. Multiple parenchymal microhemorrhages may also be related to prior radiation. Unchanged relatively larger 7 mm inferior frontal hemorrhagic lesion which may represent a cavernous malformation, possibly also related to remote radiation if there is such history.5. MR venogram demonstrates invasion and occlusion of the anterior and middle thirds of the superior sagittal sinus. The posterior aspect of the superior sagittal sinus and remainder of the major venous system remains patent.