Clinical question: CNS Nocardia. Signs and symptoms: Persistent personality changes. Pre and post enhanced brain MRI:Examination demonstrates no evidence of an acute or convincing evidence of new finding since prior exam.A well-demarcated T2 hypointense mass in the splenium of corpus callosum, extensive surrounding vasogenic edema and with uniform enhancement(presumably Nocardia) is again identified. Multiple measurements of mass on nonenhanced as well as postcontrast images demonstrate no change to possible minute interval decrease since prior exam.Extensive surrounding FLAIR hyperintensity/edema demonstrate no change.Tiny cluster of enhancement in the right paramedian posterior pons with subtle FLAIR hyperintensity also in the identical to prior exam.Multiple patchy foci of FLAIR hyperintensity on the in the periventricular and subcortical white matter of bilateral cerebral hemispheres some with susceptibility signal changes remain nearly identical to prior exam and without abnormal enhancement. Findings are likely representing mild degree of chronic small vessel ischemic strokes. There is no detectable additional foci of abnormal parenchymal or leptomeningeal enhancement.The ventricular system remains within normal size and with normal pattern of enhancement.
1.No evidence of an acute or convincing evidence of new finding since prior study.2.Focus of enhancement in the splenium of corpus callosum presumed Nocardia demonstrate no change to possible minute decreased size since prior exam.3.Stable tiny cluster of enhancement in the right para median posterior pons since prior exam.4.Stable FLAIR hyperintensity/vasogenic edema surrounding the lesion in the splenium of corpus callosum.5.Negative diffusion weighted images and findings suggestive of mild chronic small vessel ischemic strokes demonstrate no change.