70-year-old female with a history of meningioma status post multiple surgeries in 1950s-60s. History of seizures. There is evidence of multiple prior bilateral craniotomies. There are extra-axial enhancing masses along the frontal convexities bilaterally. The mass on the left measures 2.0 x 2.0 x 1.9 cm, and the mass on the right measures 2.3 x to 0.6 x 2.0 cm (series 1501, image 315 and series 1503, image 115). Both of these masses are likely invading the superior sagittal sinus. Mild nodularity elsewhere along the left convexity may represent additional smaller extra-axial masses. The dura is diffusely thickened throughout, left greater than right. In addition, there is a subdural fluid collection along the left cerebral hemisphere measuring up to 7 mm in thickness with susceptibility effect. This was either much smaller or not present on the prior CT examination. There is plaque-like dural thickening along the left pterion which may represent additional dural based tumor. Plaque-like dural thickening along the floor of the right posterior fossa is also seen. The margin of this thickening is somewhat feathered and appears to adhere to or invade the adjacent cerebellum. The right cerebellum is atrophic and demonstrates increased T2 signal. Hemosiderin stained right frontal lobe encephalomalacia and periventricular T2 hyperintensity are noted. There is also encephalomalacia involving the right temporal lobe subjacent to a burr hole and a likely left basal ganglia lacunar infarct. There is a susceptibility inducing lesion in the right inferior frontal gyrus with internal T2 signal which suggests cavernoma. There are a number of additional scattered foci of susceptibility elsewhere which are nonspecific.
1.Multiple extra-axial masses compatible with meningiomas along the bilateral frontal convexities. A plaque-like area of dural thickening is seen along the left pterion which could also represent a meningioma. Plaque-like dural thickening along the floor of the right posterior fossa with a scirrhous or adhesive appearance relative to the adjacent cerebellum. Given the cerebellar atrophy, this may reflect a chronic treated meningioma with the possibility of an atypical or invasive meningioma considered less likely. Correlation with prior exams would be helpful.2.Subdural collection along the left cerebral hemisphere, which is likely new from the prior CT exams and most likely represents a subacute or chronic subdural hematoma. Asymmetric dural thickening seen in the left hemisphere may therefore be reactive to this collection. 3.Multiple chronic findings are also seen including areas of encephalomalacia and scattered susceptibility inducing lesions which probably represent a combination of cavernomas and chronic microhemorrhage.