Other phakomatoses, not elsewhere classified [Q85.8], Reason for Study: ^Reason: With Von Hippel Lindau Syndrome and resection of cerebellar Hemangioblastomas in 4/2016 abd 2000. Evaluate for lesions. History: With Von Hippel Lindau Syndrome and resect.Additional history from Epic. Patient was initially diagnosed with right cerebellar mass in 2000 which was resected. Patient underwent additional resection for left cerebellar mass on April 4, 2016. MRI of the spine in June 20, 2016 demonstrated multiple lesions. MRI BRAIN:There is encephalomalacia in the bilateral cerebellar hemispheres related to lesion resection. There is a new enhancing 6 mm lesion in the posterior inferomedial left cerebellum (series 5, image 26). Additionally, there is a new 7 mm lesion in the superior left cerebellum (series 5, image 46). There is an approximately 4 mm enhancing lesion in the right putamen, increased since prior examination.The cortical sulci are in proportion to cerebral ventricles. There are numerous foci of T2/FLAIR hyperintensity in the periventricular and subcortical white matter without enhancement or restricted diffusion. No midline shift or mass effect is appreciated. There is no diffusion abnormality identified. There is no acute intracranial hemorrhage. There is a partially empty sella. Bilateral staphyloma are noted. There is a small retention cyst in the right maxillary sinus. Small amount of fluid is present in the left mastoid air cells.MRI CERVICAL SPINE:There is mild reversal of the cervical lordosis centered at C4-5. The vertebral heights and intervertebral disc spaces are maintained. The spinal cord demonstrates normal caliber and signal intensity. The C7-L4 vertebral bodies demonstrate diffusely new increased T1 hyperintensity, suggesting interval radiation treatment. No worrisome focal marrow signal is identified. No abnormal enhancing lesions are identified in the cervical spine.There are small disc bulges with posterior disc osteophyte complex is present at C4-5, C5-6, and to a lesser degree C6-7. There is mild effacement of the ventral thecal sac at C4-5 and C5-6. No significant cervical central or neural foraminal stenosis is noted.MRI THORACIC SPINE:The thoracic kyphosis is preserved. The vertebral bodies and intervertebral disc spaces are maintained. No worrisome focal marrow signal is identified. There is an approximately 6 x 5 mm (AP by CC) enhancing lesion intrathecal lesion abutting the left anterior spinal cord at T1-2 level, not significant changed since prior examination. A 4 mm enhancing lesion in the dorsal thecal sac at T7 level appears similar to prior examination (series 32, image 7). Additionally, in the inferior left intrathecal space there is a 3 mm enhancing lesion at the T12 level (series 31, image 2). This lesion is probably similar to prior MRI although was not well delineated on prior examination due to technique. No additional enhancing thoracic lesions are identified. No significant degenerative changes are demonstrated in the thoracic spine.LUMBAR SPINE:The lumbar lordosis is preserved. The lumbar vertebral body heights and intervertebral disc spaces are maintained. The conus terminates at L1. The cauda equina appear unremarkable. No significant degenerative changes are demonstrated in the lumbar spine. There is a 4 mm enhancing lesion present in the left intrathecal space within the cauda equina at L1-2 level which does not appear significant changed compared to prior examination.Multiple bilateral lesions are noted.
BRAIN:1.There are 2 new small enhancing lesions in the left cerebellum measuring up to 7 mm. Additionally, there is an enlarging 4 mm lesion in the right putamen.2.Bilateral cerebellar encephalomalacia related to lesion resection is again seen.3.Scattered foci of white matter T2/FLAIR hyperintensity appears similar to prior examination, related to chronic microvascular ischemic change.SPINE:1.Subcentimeter enhancing lesions in the thoracic and lumbar spine do not appear significantly changed from prior examination.2.There are radiation treatment related changes at C7-L4. 3.There are mild degenerative changes of the cervical spine without significant neuroforaminal or spinal stenosis.