Male, 50 years old, with abnormal brain MRI, status post two biopsies. Evaluate for changes over the past few MRIs. Evidence of right frontal approach and right temporal approach biopsies is again noted. A slitlike, hemosiderin stained cavity is also redemonstrated within the right basal ganglia compatible with a healed parenchymal hemorrhage.Ill-defined infiltrative T2 hyperintensity and thickening is again seen involving the right temporal lobe, insula, basal ganglia and thalamus, cerebral peduncle, splenium of the corpus callosum and centrum semiovale white matter. The overall geographic extent of this abnormality has not changed, though some of the involved gyri appear to be subjectively somewhat thicker than on the prior examination. As before, this lesion does not enhance.Generalized mass effect with a midline shift to the left of approximately 5 mm is unchanged. The right lateral ventricle is partially effaced. No brain herniation is seen. No pathologic parenchymal or extra-axial enhancement is detected. No new parenchymal lesions are seen.
There has been no convincing or measurable change in the geographic extent of the large infiltrative T2 hyperintense process involving multiple lobes of the right cerebral hemisphere. Subjectively, some of the involved gyri appear slightly thicker, but this is potentially related to differences in technique. Continued follow-up is advised.