Tremors, hypertension, delay. Patient with history of ependymoma. Brain: Compared to CT head dated 4/19/2016, there has been increase in size of the lateral and third ventricles and increase in periventricular FLAIR hyperintensity compatible with transependymal flow related to obstructive hydrocephalus. A left frontal approach ventriculostomy catheter terminates at the foramen of Monro, unchanged. Additional prior bilateral catheter tracts are noted with chronic blood products.Again seen are postsurgical changes of right occipital craniotomy related to partial tumor resection. The right occipital approach catheter traversing the right CP angle cystic lesion is unchanged in position. The cystic component at the right cerebellopontine angle is unchanged in its posterior aspect measuring 16 x 13 mm in the axial plane, although there is some decrease in the more anterior cystic component lateral to the pons in the region of the catheter tip when compared to 3/18/2016. There is mild increase in however cystic expansion along the posterior and left lateral aspect of the mass which continues as an expanded foramen of Luschka. The overall enhancing posterior fossa mass does not demonstrate significant change in size measuring approximately 45 x 50 mm, in the axial plane mass and approximately 40 mm in the craniocaudal dimension. Extension into the right upper aspect of the cervical spine is again seen to the C1-C2 level. Slight differences in enhancement are favored to be related to technique. Extensive FLAIR hyperintensity in the posterior fossa is also not significantly changed. Mass effect on the cerebellum and brainstem with leftward deviation is not significantly changed. Foci of susceptibility are again seen related to calcification within the tumor as seen on recent CT. Unchanged small pineal cyst. Diffuse paranasal sinus opacification and bilateral mastoid air cell opacification is increased since 4/19/2016.Spine: There is expansile T1 hypointensity and T2 hyperintensity involving most of the cervical cord which appears contiguous with the central canal, extending inferiorly to the C7 level, which is new since prior spine MRI from 9/9/2015. Signal abnormality measures up to 7 x 10 mm in the axial plane at the C4 level. More recent dedicated spine imaging is not available, although there is some suggestion of abnormal signal in the partially imaged upper cervical cord on recent brain MRI studies.No abnormal medullary or leptomeningeal enhancement is appreciated to suggest drop metastases in the spine. Visualized osseous structures in the spine are unremarkable.There is fibrofatty infiltration of the filum terminale measuring less than 2 mm. Conus terminates normally at the upper L2 level.
1. Interval increase in size of the ventricular system consistent with development of hydrocephalus. There is associated evidence of transependymal CSF flow. Left frontal ventriculostomy catheter appears unchanged in position.2. Overall size of the posterior fossa ependymoma is not significantly changed. Compared to prior studies dating back to 3/18/2016, there is slight decrease in size of the of the cystic component involving the anterior aspect of the cerebellopontine angle cistern. There is mild increase in cystic/fourth ventricular expansion dorsal and along the left lateral aspect of the mass, which is contiguous with the left foramen of Luschka.3. No evidence of drop metastasis in the spine. 4. Abnormal expansile T2 signal is seen throughout the central cervical cord, which is contiguous with the central canal and extends to the C7 level, likely representing a syrinx. This finding is new since prior complete spine MRI from 9/9/2015. More recent dedicated spine imaging is not available, although there is some suggestion of abnormal signal involving at least the partially imaged upper cervical cord on recent brain MRI studies.5. Fibrofatty infiltration of the filum terminale. Conus terminates normally at the upper L2 level without clear imaging evidence of cord tethering.Dr. Ali discussed findings of hydrocephalus with Dr. Retondo-Rudkinsky at 1600 hrs on 5/6/2016. 