Male, 72 years old, with altered mental status. Assess for swelling, radiation effect or tumor. Postoperative findings are seen compatible with right parietal craniotomy and paramedian parietal craniectomy with mesh cranioplasty. A small pocket of extra-axial fluid is seen subjacent to the craniectomy which is unchanged from prior.Since the prior examination, an irregularly enhancing nodule of presumed residual tumor along the left parietal lobe at the upper aspect of the resection cavity has increased in size from approximately 20 mm to 30 mm. This lesion is contiguous with nodular tumor at the inferior aspect of the resection cavity, spanning the midline, which has also substantially increased in size.Edema and T2 signal abnormality within the left parietal lobe have increased from prior. Edema and T2 signal abnormality within the right parietal lobe are relatively unchanged. Areas of cystic degeneration within the right parietal lobe are stable to slightly smaller.Redemonstrated are scattered nonspecific foci of brain parenchymal T2 hyperintensity. No restricted diffusion is seen. No acute intracranial hemorrhage is suspected. Apart from the residual and/or growing tumor, no new enhancing lesions are seen. The lateral and third ventricles are slightly more prominent than on the prior examination but are not frankly dilated.On MR imaging, no high-grade intracranial vascular stenosis or occlusion is suspected. No aneurysm or vascular malformation is observed. The right vertebral artery is congenitally small and primarily supplies the right PICA. Prominent bilateral PCOM arteries are present. The ACOM artery is small and unremarkable.
1.Findings are seen concerning for progression of tumor at the site of prior tumor resection in the high parietal regions.2.Slight progression of edema in the left parietal lobe. Stable edema and cystic encephalomalacia in the right parietal lobe.3.No acute intracranial abnormality.4.No intracranial vascular compromise.