52 years Female (DOB:5/14/1963)Reason: History of metastatic renal cancer and MS. s/p SRS. Assess for progression (on bevacizumab) History: MS symptoms stablePROVIDER/ATTENDING NAME: WALTER M. STADLER WALTER M. STADLER There is a patchy focus of susceptibility effect present in the right parietal lobe associated with T2 and FLAIR signal hyperintensity. There is some punctate foci of contrast enhancement associated with this. Compared to the October exam there is less enhancement on the current exam versus the prior exam. There also appears to be more volume loss on the current versus the prior exam.There is a smaller focus of signal loss on susceptibility imaging associated with contrast enhancement and T2 and FLAIR signal hyperintensity located in the superior aspect of the left cerebellar hemisphere which was larger on the prior exam than on the current exam. This contrast enhancing focus currently measures approximately 4 mm and previously measured approximately 14 x 16 mm.The right cerebral peduncle is smaller than the left cerebral peduncle. There is T2 signal hyperintensity along the posterior limb of the right internal capsule tracking down into the right cerebral peduncle. This is stable compared to the prior exam. It likely represents Wallerian degeneration.There is a moderate degree of periventricular and subcortical confluent hyperintense white matter lesions present identified on the FLAIR and T2 images.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.
1.Since the prior exam lesions in the right parietal lobe and left cerebellar hemisphere have regressed2.There is a moderate degree of periventricular white matter lesions present which are long-standing.3.Findings suggest long standing wallerian degeneration.