Diagnosis: Intracranial abscess and granulomaClinical question: progression of abscessSigns and Symptoms: previous imaging c/w abscess There is redemonstration of ventriculomegaly. The lateral ventricles at the level of foramen of Monro on coronal imaging measures 7 mm on the current exam and on the prior exam measured the same. The third ventricle measures 21 mm on the current exam and previously measured the same.There is redemonstration of a cystic lesion located in the left parietal lobe measuring approximately 18 x 14 mm axial dimensions which previously measured 18 x 14 mm axial dimensions. There is some associated susceptibility effect. There is associated diffusion restriction within this cystic appearing component. There is a vasogenic pattern of edema surrounding this lesion which was also present on the prior exam. This vasogenic edema appears to have partly regressed when compared to the prior exam.There is redemonstration of periventricular confluent T2 and FLAIR signal hyperintensities.Punctate T2 and FLAIR hyperintense foci are present in the brainstem and unchanged since the prior exam.There are punctate foci of susceptibility in the posterior aspect of the left insular cortex as well as the fourth ventricle which were also present on the prior exam.Previously noted small-enhancing lesions in the right posterior insular cortex and the right inferior parietal lobule are not readily appreciated on this exam most likely due to lack of contrast enhancement on the current exam.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 right vertebral artery is small.The visualized portions of the paranasal sinuses demonstrate mucosal thickening in the sphenoid sinus on the right side. The visualized portions of the mastoid air cells demonstrate partial opacification of right mastoid air cells. The visualized portions of the orbits are intact.
1.A hemorrhagic and cystic lesion present in the left parietal lobe has not changed substantially when compared to the prior exam. One possibility is that this represents an abscess. Compared to the prior exam there is less vasogenic edema associated with this lesion.2.Ventriculomegaly is stable and compared to the prior exam.3.Periventricular white matter lesions are stable compared to the prior exam.4.There is a hemorrhagic lesion along the posterior aspect of the left insular cortex.