43 years Male (DOB:9/10/1972)Reason: 43 yo R-handed man w/ recurrent GBM, WHO grade IV, IDH1 R132H mut, ATRX wt; s/p resection 7/7/2014 and 3/7/16; s/p RT/TMZ followed by cyclic TMZ x 12-13 cycles (completed 10/2015) plus rindopepimut; compare to prior uploaded scans History: 43 yo R-handed man w/ recurrent GBM, WHO grade IV, IDH1 R132H mut, ATRX wt; s/p resection 7/7/2014 and 3/7/16; s/p RT/TMZ followed by cyclic TMZ x 12-1PROVIDER/ATTENDING NAME: RIMAS V LUKAS RIMAS V LUKAS The patient is status post a right sided craniotomy for removal of a a right inferior parietal lobule and adjacent temporal lobe mass. There is a CSF collection present at the tumor removal site. There is a heterogeneously enhancing lesion present along the posterior and inferior aspect of the tumor resection site which is suggestive of some residual tumor. It measures approximately 22 x 11 mm in sagittal dimensions and is associated with high cerebral blood volume. There is a small enhancing linear nodule along the superior aspect of the tumor resection site which could represent a vascular structure or residual tumor. A couple punctate nodules of enhancement along the margins of the tumor resection site medially. These punctate nodules are best seen on sagittal sequence #1301 image 22 and 23.Since the prior exam the patient has developed bilateral subdural effusions.Since the prior exam an arachnoid cyst in the left middle cranial fossa has changed signal characteristics. Subarachnoid cyst measures 58 x 41 mm axial dimensions on the current exam and previously measured similar dimensions. On susceptibility weighted imaging appears to be some siderosis along the surface of the left temporal lobe.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.
1.Since the prior exams the patient has developed bilateral subdural effusions which have a somewhat heterogeneous signal. It is possible that there is proteinaceous debris within these subdural collections which in part may represent blood.2.Since the prior exam an arachnoid cyst in the left middle cranial fossa although has not changed dramatically in size has changed in signal characteristics raising the question of hemorrhage within the cyst.3.Since the prior exam a right inferior parietal lobule and temporal lobe mass has been removed. There are enhancing components present along the margins of the tumor resection site as detailed above which are suspicious for either residual tumor or recurrent tumor.