Diagnosis: Unspecified persistent mental disorders due to conditions classified elsewhere. Neoplasm of unspecified nature of brain.Clinical question: A 84-year-old female, follow up brain tumor and memory impairmentSigns and Symptoms: memory impairment The CSF spaces are appropriate for the patient's stated age with no midline shift. The patient is status post left frontal lobe surgery and left frontal craniotomy. There is gliotic change present in the left frontal lobe adjacent to the surgical site associated with some cystic encephalomalacia. Compared to the prior exam of 5/27/2005 the extent of the white matter T2 signal hyperintensity has not changed significantly.A small cystic type focus in the medial aspect of the left temporal lobe is stable. There are now some surrounding signal changes in the adjacent white matter.There is relative volume loss in the right cerebellar hemisphere relative to the left cerebellar hemisphere which is more evident on the current versus the prior exam.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. Since the prior exam these periventricular and subcortical lesions have mildly increased in number.No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.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 demonstrate a mucous retention cyst in the left maxillary sinus which to some degree is also present on the prior exam.. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.
1.The patient status post left frontal surgery. Gliosis in the left frontal lobe remains stable compared to the prior exam.2.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related. This has mildly progressed since the prior exam from 2005.3.Since the prior exam right cerebellar atrophy has progressed. In addition generalized atrophy has increased as would be expected with age.