Male, 55 years old, with disorder of brain, unspecified, preoperative examination with contrast for Stealth. Extensive edema is evident within the right parietal lobe and minimally the occipital lobe. On precontrast T1-weighted images, the cortex of the right inferior parietal lobule is hyperintense compatible with recent prior contrast administration. On postcontrast images, the juxtacortical tissues in this area demonstrate superimposed intense rim enhancement which extends from the brain surface to the ventricular margin. There is a small satellite nodule of enhancement more superiorly along the postcentral sulcus on the right. The overall lesion is relatively wedge-shaped. Regional mass effect results in effacement of the right ventricular atrium and occipital horn. No evidence of herniation is seen. In the left parietal lobe, relatively mild edema is seen straddling the intraparietal sulcus. Multiple small areas of linear and/or ring enhancement are also seen in this location, all much smaller than the lesion on the right. No significant generalized mass effect is evident on the left. No additional enhancing lesions are seen. On comparison with the prior outside examination, the above described findings have not significantly changed. The lesions are, however, new when compared to a prior CT from 09/29/16.
Bilateral parietal lesions are identified, right side more than left, showing cortical and juxtacortical ribbonlike enhancement. The affected cortex of the right inferior parietal lobule is slightly blurred but it does remain evident. The distribution and morphology of the lesions suggest a vascular process. Evolution of ischemic injury could account for some of the imaging features. However, there could also be a superimposed infectious component with septic embolic disease a distinct possibility. Lesion morphology is not entirely typical of a pyogenic agent, and as such, atypical and even fungal etiologies should be considered.