Patient with history of glioblastoma multiform he currently on clinical trial with Temodar and investigational agent. Please compare to baseline study exam from 4/7/2015 using RANO criteria. The study is significantly degraded by motion artifact. There is interval development of a right-sided subdural collection with mixed signal, measuring 20 mm in maximum width. There is associated mass effect on the underlying parenchyma as well as right to left midline shift of 12 mm with subfalcine herniation. There is partial effacement of the right lateral ventricle and new dilatation of the left lateral ventricle with subependymal signal change, suggestive of entrapment and transependymal CSF flow.There are postoperative findings related to right posterior temporal parietal craniotomy with unchanged small epidural collection subjacent to the craniotomy site. There is interval increase in the lobulated enhancement surrounding the resection cavity. Perfusion imaging is unreliable as it is degraded by motion artifact. There is progression of surrounding FLAIR signal hyperintensity around the right temporal parietal resection. The resection cavity appears slightly smaller. There is susceptibility artifact associated with the resection cavity.
1.Interval development of right-sided subdural hematoma likely of mixed chronicity with a maximum width of 20 mm, contributing to mass effect on the underlying parenchyma, leftward midline shift of 12 mm, and partial effacement of the right lateral ventricle with entrapment of the left lateral ventricle.2.Interval increase in enhancement surrounding the resection cavity; however, perfusion imaging is unreliable as it is degraded by motion artifact. Interval progression of edema around the resection cavity. Given the fact that the patient is on immunomodulatory treatment, this may represent a inflammatory or immune-mediated phenomenon. Progression of disease is not excluded however.Urgent findings discussed with Dr. Lukas on 6/1/2015 at 1 pm.