66 years, Male, GBM. Left-sided weakness and neglect. Again seen are postsurgical changes of right-sided craniotomy for tumor resection. Again seen is a heterogeneously enhancing right cerebral hemisphere mass with surrounding FLAIR hyperintensity centered in the deep white matter of the right frontal lobe. Compared to 6/17/2016 there is increase in size of the enhancing solid mass particularly medially with increased extension into the right thalamus and into the right midbrain. Increased involvement of the right anterior basal ganglia is also noted. Necrotic components and hemorrhagic components within the tumor are again seen. No evidence of infarct or new discrete hematoma. Mass effect including effacement of the right lateral ventricle has worsened. Leftward midline shift measured at the level of the foramen of Monro measures 14 mm, previously approximately 9 mm measured similarly. There is also mild interval increase in size of the left lateral ventricle with surrounding FLAIR hyperintensity indicating entrapment. Uncal herniation is also worsened since prior.
Compared to 6/17/2016, there is evidence of further progression of right cerebral hemispheric glioblastoma with particular increasing solid components involving the right anterior basal ganglia and thalamus, with slight extension into the right midbrain. Associated mass effect has also progressed as described above including worsened leftward midline shift and uncal herniation with entrapment of the left lateral ventricle.