70 years Male (DOB:2/20/1946)Reason: LUE weakness s/p seizure History: as abovePROVIDER/ATTENDING NAME: JAMES AHN CHRISTOPHER M GOMEZ MRI of the brainThere is a mass involving gray and white matter located in the right superior and middle frontal gyri extending to the anterior most aspect of the right precentral gyrus at the hand motor area. It measures approximately 40 x 30 mm in axial dimensions. It measures approximately 40 x 33 mm in sagittal dimensions is associated with a small amount of contrast enhancement along its inferior aspect. It involves both gray and white matter. On FLAIR imaging and has a heterogeneous appearance. Along its medial aspect is associated with the punctate focus of susceptibility effect which on CT appears to represent a small calcification.The patient status post right frontal bone burr hole placementNormal 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 are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified and is small. The A1 segments are similar in diameter. The posterior communicating arteries are intact. The left posterior communicating artery is larger than the right posterior communicating artery. The left vertebral artery is smaller than the right vertebral artery.MRA neck:There is opacification of the aortic arch, great vessels from the aortic arch and carotid arteries and vertebral arteries. There is no stenosis identified of the great vessels from the aortic arch. On the basis of NASCET criteria there is no significant stenosis at the carotid bifurcations. There is no significant stenosis along the course of the vertebral arteries. The left common carotid artery originates from the innominate artery. Left vertebral artery originates from the aortic arch.
1.There is a mass present in the right frontal lobe involving the medial and posterior aspect of the right superior frontal gyrus, the lateral and posterior aspect of the right middle frontal gyrus as well as the anterior aspect of the right precentral gyrus at the level of the hand motor area. Most likely this represents a neoplasm such as a primary brain tumor possibly oligodendroglioma.2.There is no evidence for intracranial or extracranial cerebrovascular occlusive disease.