Clinical question: Headaches, history of GBM, post radiation. Signs and symptoms: As above Non-enhanced head CT:The examination demonstrates new area of low attenuation in the right basal ganglia measuring 13.9 x 14.5-mm on axial image 10. This finding could represent a lacunar infarct however possibility of tumor cannot be excluded. A smaller second similar lesion more posteriorly with extension into the thalamus is also present. Follow-up with an MRI is recommended. There is also a large area of CSF density well-demarcated collection measuring 33.5 x 33.6-mm in transaxial dimension and approximately 44 mm in cranial -- cephalad access. This is suspected for a cyst formation at the surgical site and or cystic tumor.The combination of above findings results in effacement of adjacent cortical sulci and subtle mass effect on the third ventricle and right lateral ventricle which appears a slightly smaller than before. There is also midline shift of approximately 4.6 mm to the left at the level of septum pellucidum.There is a small extra-axial collection likely subdural in the right frontal region anterior to the anterior edge of right frontal craniotomy flap which measures approximately 36 mm in length and 8.3 -mm in thickness which is measured on axial image 13.New since prior exam there is also a cortical based low attenuation of the left anterior frontal lobe that is suspected for a small cortical stroke. This finding is appreciated on axial images 13 to 15.A punctate size calcification at the anterior aspect of third ventricle is this could represent a small colloid cyst which was also noted before and report change.
1.Suspect a small left frontal cortical stroke, local nor stroke of right basal ganglia as detailed above.2.Large cyst formation at the surgical site in the right temporal lobe measuring approximately 32.5 x 33 x 44-mm concerning for a cyst or a cystic tumor.3.Well-demarcated a small low-attenuation lesions in the right basal ganglia concerning for strokes and or tumor.4.A small CSF density subdural in the right frontal region measuring 36-mm in length and 8.3-mm in thickness.5.Combination of above findings results in further subtle increase in mass effect on the right lateral ventricle and midline shift of approximately 4.6 mm.6.Constellation of all these new findings require further evaluation with a dedicated MRI examination.