Right oculomotor nerve palsy. History of brainstem astrocytoma. The well-circumscribed, mixed cystic and solid mass involving the mid brain has not significantly changed since the previous examination. It measures anteroposteriorly 2.3 cm, transversely 1.7 cm and craniocaudally 2.1 cm. The cystic foci within the mass and along the interface between the mass and the adjacent brain parenchyma remain unchanged. There continues to be no peritumoral edema and mass-effect remains mild. Following contrast injection, the mass shows no significant enhancement.There is a 5 mm focus of diffusion restriction involving the right external capsule correlating with mild T1/FLAIR hyperintensity. This probably represents a recent infarct. There is focal encephalomalacia from a prior infarct/insult in the right cerebellar hemisphere, which is unchanged. Otherwise, there are dilated perivascular spaces in the deep gray nuclei regions and brainstem. A prominent CSF intensity lesion in the left globus pallidus measuring up to 7 mm and may represent a dilated perivascular space or a chronic lacunar infarct. There are also small patches of T2 hyperintensity in the cerebral white-matter which are mildly increased since the prior examination. Mild global brain volume loss is unchanged as is associated mild ventricular and sulcal enlargement. Major intracranial vascular flow voids are preserved. There are numerous tiny foci of susceptibility effect clustered within and around the brainstem and adjacent tissues which may be related to prior radiation. There are also foci of susceptibility effect related to the encephalomalacia in the right cerebellar hemisphere.Dynamic susceptibility-weighted contrast-enhanced MR perfusion shows lack of significant hyperperfusion within the brainstem mass or adjacent tissues.
1.Tiny but acute/recent right external capsule infarct.2.The brainstem glioma is unchanged since the 2007 examination.3.Otherwise, mild cerebral white-matter signal abnormality is nonspecific but may reflect chronic microvascular ischemia in addition to unchanged focal right cerebellar encephalomalacia/gliosis.Dr. Monther Qandeel sent the above findings to Dr. Jeffrey W Nichols by email on 5/11/2016 3:40 PM. 