History mantle cell lymphoma. Brain: There is now diffuse enlargement and enhancement of bilateral trigeminal nerves and new enhancement along the bilateral cranial nerve 7 and 8 complexes, particularly in the internal auditory canals, right greater than left, as well as the bilateral oculomotor nerves and bilateral cranial nerve 10 and 11 complexes. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is a right transfrontal Ommaya catheter. There is extensive confluent cerebral white matter T2 hyperintensity. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is a small left maxillary sinus retention cyst.Cervical Spine: There is persistent diffuse enlargement of multiple bilateral cervical and upper thoracic extraforaminal enhancing nerve roots. Otherwise, there is no evidence of tumor or abnormal enhancement within the cervical spinal canal. The spinal cord displays normal signal and morphology. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is unchanged mild multilevel degenerative spondylosis, but no significant spinal canal stenosis. The paravertebral soft tissues are unremarkable.
1. Interval increased and new enhancement and enlargement involving multiple cranial nerves, which is suggestive of lymphoma progression.2. Persistent diffuse enlargement of multiple bilateral cervical and upper thoracic extraforaminal enhancing nerve roots likely related to lymphoma. 