Male, 20 years old, with von Hippel-Lindau disease and pre-existing brain and spine hemangioblastomas. Evaluate for new or growing lesions including within the internal auditory canal. Brain:An enhancing focus within the far inferior left cerebellum has increased in size, now measuring 7 mm in diameter, previously 4 mm. Mild surrounding parenchymal edema has also increased slightly from prior. An additional faintly enhancing 3 mm lesion more superiorly within the left cerebellum has not convincingly changed.No additional pathologic intracranial enhancement is seen. There is a developmental venous anomaly within the paramedian right parietal lobe. Cerebral morphology is within normal limits. No evidence of generalized mass effect is seen. No acute intracranial hemorrhage or any abnormal extra-axial fluid collections are detected. The ventricles are normal in size and morphology.Spine:A 3 mm enhancing nodule along the dorsal surface of the cervico-medullary junction is unchanged. There is no significant edema associated with this lesion.A 6 mm enhancing nodule along the dorsal surface of the spinal cord at T5-6 may be minimally increased in size in comparison to prior examination. However, there is new mild associated cord edema spanning the T5 and T6 vertebral bodies. More superiorly, at the T5 level, a punctate focus of enhancement along the dorsal cord is unchanged.A 2 mm focus of enhancement is evident along the left lateral cauda equina at L2. No adequate prior examination exists in this area for comparison. The conus and cauda equina are otherwise unremarkable.Spinal alignment is anatomic. Vertebral body height and morphology are within normal limits. No concerning marrow replacement, edema or pathologic enhancement is seen. A shallow left paracentral disc protrusion is seen at T11-12. No areas of high-grade spinal canal or foraminal stenosis are detected.
Multiple small enhancing lesions are identified within the brain and spine compatible with hemangioblastomas. One such lesion in the left inferior cerebellum has increased slightly in size. A punctate lesion more superiorly within the left cerebellum is unchanged.A 3 mm nodule along the dorsal cervical medullary junction is unchanged. A 6 mm lesion along the dorsal spinal cord at T5-6 may be slightly larger than on the prior examination, but associated edema has more clearly progressed. A punctate enhancing lesion along the dorsal cord at T5 is unchanged.A 2 mm focus of enhancement along the left lateral cauda equina at the L2 level is demonstrated and could represent an additional small hemangioblastoma. No adequate prior examination is available for comparison.