70 years, Male, history of pineal tumor, pseudogout, Rickham, third ventriculostomy. Altered mental status. Multiple sequences are motion degraded. Partially necrotic pineal tumor, status post laser ablation, is better assessed on recent post gadolinium brain MRI from 11/20/2016 but grossly unchanged. There is slight decrease in edema in the adjacent thalami and midbrain. Blood products within the tumor as well as within the ventricular system are again evident. There is no restricted diffusion to suggest acute ischemia. Again seen is a right transfrontal ventriculostomy catheter with the tip in its unchanged position in the anterior right lateral ventricle along the septum pellucidum. Mild ventriculomegaly is not significantly changed since 11/28/2016. Patency of the third ventriculostomy is not adequately assessed on the current study. Extra-axial collection along the right frontotemporal convexity measuring up to 10 to 12 mm is minimally larger. Adjacent local sulcal effacement is similar to prior. There is minimal leftward midline shift as before. No uncal herniation. T2/FLAIR hyperintensity in the bilateral subcortical and periventricular white matter is not significantly changed. Right occipital lobe encephalomalacia again seen.There is nonspecific opacification of the mastoid air cells, left greater than right. Left occipital exophytic scalp nodule is again seen and can be correlated with direct examination.
1. No evidence of acute infarct.2. Partially necrotic pineal tumor, status post laser ablation, is not well assessed without contrast but grossly unchanged since 11/20/2016. Edema involving the adjacent thalami and midbrain appears minimally improved. Hemorrhage within the tumor as well as within the ventricular system again seen.3. Mild ventriculomegaly is not significantly changed. 4. Subdural collection along the right frontotemporal convexity is minimally larger in the interval.