Clinical question: 74 year old male with glioblastoma multiforme. On anticoagulation for acute DVT. Now with acute decline in mental status. Signs and symptoms: Obtunded. Nonenhanced CT of brain:Very poor study due to extensive motion artifact. New since prior examination is a large area of vasogenic edema in the left anterior, mid and posterior temporal lobe with significant effacement of adjacent cortical sulci. There is no significant mass effect on the lateral ventricle and no midline shift is detected. Findings are concerning for increased/recurrence of tumor and should be further evaluated with a dedicated MRI examination.Ventricular system remain within normal size and stable since prior study. No additional findings.
1.Significant new area of vasogenic edema in the left temporal lobe concerning for increase in the size of patient's known left temporal lobe glioblastoma. 2.No evidence of midline shift or hydrocephalus or any additional findings.3.Follow-up with an enhanced MRI is recommended.