Female, 38 years old, with altered mental status and history of neurosarcoid. Assess for active neurosarcoid lesions. Evidence of prior right frontal approach biopsy is again seen. Ill-defined, predominantly subcortical T2 hyperintensity without mass effect is redemonstrated in the right upper lobe showing no significant interval change. Mild periventricular T2 hyperintense rimming and scattered additional small foci of T2 hyperintensity are also unchanged.No evidence of acute intracranial hemorrhage or any abnormal extra axial fluid collection is seen. Hemosiderin staining is evident in the right frontal lobe likely related to prior biopsy. Smudgy susceptibility effect which may reflect hemosiderin staining is also seen scattered through the cerebral hemispheres, particularly in the occipital lobes, without interval change. Note is made of prominent transmedullary veins.On postcontrast imaging, diffuse fine leptomeningeal enhancement is seen involving both cerebral hemispheres symmetrically. These findings have become more conspicuous when compared to the prior examination. The pituitary infundibulum also enhances somewhat more conspicuously than what is typically seen.No restricted diffusion is evident. No significant generalized mass effect is noted. The ventricles remain mildly prominent but similar in caliber to the prior examination.
1.Diffuse leptomeningeal enhancement has become more prominent when compared to the prior examination. This could represent a neurosarcoid flare.2.Signal abnormality in the right frontal lobe status post prior biopsy, and scattered additional areas of parenchymal signal abnormality, are not significantly changed and may represent sites of prior neurosarcoid involvement.