Reason: tumor recurrence, ischemia, abscess History: somnolence The patient is status-post right-sided craniotomy for right temporal lobe surgery and right frontal lobe surgery. There is a right-sided subdural collection present measuring 10 mm in thickness.There is a contrast enhancing lesion present along the posterior aspect of the right temporal lobe measuring approximately 24 by 21 mm in axial dimensions and 31 x 19 mm coronal dimensions. It is adjacent to the trigone of the right lateral ventricle. It is associated with a ependymal enhancement. There is associated enhancement along the temporal lobe at the sylvian fissure extending to the posterior aspect of the insula. There is associated susceptibility effect within the focus of enhancement. There is abnormal T2 and flair signal present within the white matter of the right temporal lobe in the gray and white matter of the insular cortex as well as right basal ganglia and internal capsule and external capsule. This temporal lobe enhancing lesion is not clearly associated with elevated cerebral blood volume. Part of the enhancing lesion has elevated CBV, however, this may represent adjacent choroid (The perfusion study is degraded by patient motion).There is a contrast enhancing lesion present along the anterior/inferior aspect of the right frontal lobe associated with adjacent T2 and flair signal hyperintensity. This frontal lobe enhancing lesion is associated with what appears to be elevated cerebral blood volumeThere is a focus of diffusion restriction present along the posterior limb of the right internal capsule extending to the right cerebral peduncle which is associate with contrast enhancement and loss of signal on SWI. CBV evaluation is not clear.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.There is midline shift with 8mm shift of the septum pellucidum to the left.
1.Status with right-sided craniotomy for tumor surgery. The right-sided subdural effusion present which is somewhat larger on the current versus the prior exam . It is associated with midline shift2.There is an enhancing lesion present along the right temporal lobe and insular cortex. Differential considerations include radiation necrosis, infection and recurrent tumor.3.Right internal capsule and cerebral peduncle lesion is new. Differential considerations include radiation necrosis, infection and recurrent tumor.4.Right frontal lobe lesion is new. Differential considerations include radiation necrosis, infection and recurrent tumor.5.Exam is somewhat compromised due to patient motion which confounds interpretation.