Clinical question: History of epidermoid cyst. Evaluate for change. Signs and symptoms: Headache. Pre and post enhanced brain MRI:Examination demonstrates a loculated extra-axial T1 hypointense, T2 hyperintense, FLAIR hyperintense restricted diffusion in the medial right anterior temporal lobe which partially herniates through the tentorium into the right perimesencephalic cistern similar to prior exam. A larger slightly more posteriorly located similar signal changes in the right posterior medial temporal and perimesencephalic cistern similar to prior exam consistent with patient's known epidermoid tumor. The largest transaxial dimensions of the more anteriorly located component of tumor is 22.5 x 25 mm compared to prior study measurement of 22 x 23.5 mm. There is subtle associated mass effect of this component of tumor on the right cerebral peduncle. The larger contiguous more posteriorly located component of epidermoid demonstrate interval increased size and measures at 21 x 28 mm in transaxial dimensions compared to prior study re-measurements of 17.5 x 23 mm. There is also subtle interval increased size and mass effect of the infratentorially herniated component of epidermoid on the superior aspect of right cerebellar. There is no edema of the adjacent brain parenchyma. Similar to prior exam there is expected restricted diffusion of epidermoid and without abnormal enhancement. The anatomical morphology and signal intensity of brain parenchyma is otherwise within normal on all MRI sequences and without change since prior study.Ventricular system remains within normal and with maintained midline. There is no detectable abnormal parenchymal or leptomeningeal enhancement.Calvarium has normal signal intensity and without abnormal enhancement.Unremarkable images through the orbits and including axial fat sat post enhanced series.
1.No acute intracranial process.2.Examination redemonstrates a loculated right medial temporal and right perimesencephalic cistern epidermoid with interval increased size of its more posteriorly located perimesencephalic and infratentorially herniated components with resultant increased mass effect on the superior aspect of right cerebellum as detailed/measured above. 3.Unremarkable pre and post enhanced brain MRI otherwise.