Diagnosis: Disorder of brain, unspecifiedClinical question: preop planning for Brain biopsySigns and Symptoms: left hand weakness There is a 27 x 26 mm axial dimension mass centered in the posterior aspect of the right frontal lobe associated with surrounding vasogenic edema which has heterogeneous enhancement. On 12/5/2015 and measured 15 x 17 mm axial dimensions. It involves part of the right precentral gyrus. The septum pellucidum is now shifted approximately 5 mm to the left of midline.There is T2 signal hyperintensity present along the right insular cortex and right anterior and medial temporal lobe as well as right basal ganglia and internal capsule. There is also T2 hyperintensity present along the medial aspects of the frontal lobes and along the gyrus rectus. It is not associated with contrast enhancement. It has not changed substantially since the prior exam.The uncus is displaced medially but not different than on the prior exam.There are patchy T2 hyperintense periventricular white matter lesions present.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 demonstrate a small mucous retention cyst in the right maxillary sinus. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.
1.Since the prior exam a mass centered in the right frontal lobe has enlarged and is associated with more vasogenic edema. Given the significant enlargement over a short period of time, in addition to neoplastic process, an infectious process should be considered in differential. There is mild midline shift associated with this now.2.There is abnormal thickening and abnormal signal involving the right anterior and medial temporal lobe and insular cortex , right inferior frontal gyrus, bilateral medial frontal lobes as well as periventricular white matter in the internal capsule. This is nonspecific. One possibility is that this represents an encephalitis. Another possibility is that this is paraneoplastic3.This is a limited exam performed for the purpose of the stereotactic guidance.