Female, 38 years old, history of craniopharyngioma status post drainage and radiotherapy in 2016, presenting with confusion and acute left-sided weakness. Evaluate for new lesions, diffusion changes, block to CSF flow. Image quality is degraded by motion artifact on several sequences. Within this limitation, the following observations are made.Redemonstrated is the patient's predominantly cystic and rim-enhancing lesion involving the sella and suprasellar cistern. As before, this lesion encroaches significantly upon the third ventricle, and there is a component of the lesion which projects through the left foramen of Monro into the left lateral ventricle. There has been no interval growth of either the cystic component or of the minimal solid tissue at its caudal aspect. However, there is a new fluid-fluid level layering dependently within the cystic component of the lesion.The left lateral ventricle remains significantly dilated and on close comparison with the prior examination the degree of dilatation has likely progressed by several millimeters. Dilatation has more clearly progressed when compared to older exams. In addition, there is progressive T2/FLAIR hyperintensity along the margins of the left lateral ventricle. The right lateral ventricle is compressed but shows slight increased caliber relative to the prior examination. The fourth ventricle is normal.No restricted diffusion is seen. No new intracranial lesions are detected. There is no evidence suggest acute intracranial hemorrhage.
Although the patient's predominantly cystic craniopharyngioma shows no significant or gross interval change in size, there is a new fluid-fluid level layering dependently within the cystic component. This could represent layering proteinaceous debris or blood product.As on prior examinations, the lesion significantly encroaches upon the third ventricle and projects through the left foramen of Monro into the left lateral ventricle likely causing obstruction. The left lateral ventricle is dilated and this has worsened over multiple prior examinations. Periventricular signal abnormality around the left lateral ventricle has also increased likely representing transependymal CSF flow.