 Examination is obtained without contrast. There is no evidence of acute infarct, hemorrhage, or other new findings when compared to prior. There is no gross change in the appearance of the diffuse bilateral hypothalamic-optic gliomas with lack of contrast and absence of dedicated orbital sequences limiting optimal comparison.Supracerebellar CSF intensity collection demonstrates no significant change in size since 11/13/2015 measuring approximately 16 mm in the craniocaudal dimension and 3 cm in the AP dimension in the midline. There is also no significant change in mass effect upon the underlying tectum, which remains thickened and demonstrates T2 signal at the level of the cerebral aqueduct and compatible with tectal glioma. No significant change in mild downward mass effect on the cerebellum. There is stable focal effacement of the cerebral aqueduct.Stable lateral and third ventricular dilatation as well as periventricular T2/FLAIR hyperintensity likely relating to chronic transependymal CSF flow. Surgical tracts related to prior ventriculostomy. There are stable foci of non-enhancing T2 hyperintensity in the anterior left frontal lobe and cerebellar white matter which are nonspecific, although the cerebellar findings likely represent FASI of NF-1. There is also no significant changes in the crowding at the foramen magnum with slightly pointed cerebellar tonsils. Cervicomedullary junction which is masslike also appears to be unchanged, with T2/STIR hyperintensity within this lesion better appreciated on prior spine studies. Mild retroflexion of the dens with platybasia also contribute to narrowing at the foramen magnum.
1. No acute findings. No appreciable change in the diffuse hypothalamic/optic gliomas although lack of contrast and dedicated orbital sequences limit optimal comparison.2. No significant change in ventricular dilatation and evidence transependymal flow. Supracerebellar cistern enlargement which demonstrates mass effect on the tectum is also not significantly changed.3. No significant change in tectal lesion which is compatible with a low-grade glioma. Masslike thickening at the cervicomedullary junction which is also suspected to be related to neoplasm is also not significantly changed. Crowding at the foramen magnum is also not significantly changed.