Diagnosis: Primary central nervous system lymphoma, unspecified site, extranodal and solid organ sitesClinical question: Primary CNS NHLSigns and Symptoms: Evaluate for continued remission The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a mild to moderate degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. There are multiple small foci of signal hyperintensity on T2 and FLAIR MR imaging in the basal ganglia (more on the right basal ganglia versus the left). These are stable and compared to the prior exam from JuneThere is a punctate focus of signal hypointensity on susceptibility imaging along the medial aspect of the left cerebellar hemisphere. A focus of signal hypointensity on susceptibility imaging is present in the left cerebellar hemisphere in a small focus of encephalomalacia. On the MRI from 5/15/2014 there is an enhancing lesion in this location.No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.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.No abnormal enhancing lesions are appreciated within the brain parenchyma to suggest CNS lymphoma.2.There are periventricular white matter lesions and subcortical white matter lesions as well as lesions in the basal ganglia and cerebellum which are stable and compared to the prior exam from June. These are nonspecific. Some of these may be vascular related and others may be posttreatment related.