Clinical question: Evaluate for growth of grade lll oligodendroglioma. Signs and symptoms: Grade lll oligodendroglioma. Pre and post enhanced brain MRI:No diffusion-weighted abnormalities.Examination demonstrates interval near complete resolution of bilateral (left greater than right) subdural collections since prior exam with minimal residual left anterior temporal subdural remaining.There is postoperative changes of right temporal craniotomy with right anterior temporal lobectomy. Posterior to the surgical site there is a large focus of cystic encephalomalacia and extensive surrounding gliosis involving the right temporal lobe and with extension into the right basal ganglia similar to prior exam. Similar to prior exam there is ex vacuo dilatation of right anterior temporal horn. There is also no detectable parenchymal enhancement.Interval resolution of a small focus of previously suspected hemorrhagic contusion along the interhemispheric aspect of left frontal lobe since prior study. Patchy foci of cortical encephalomalacia in the left anterior frontal lobe without enhancement is present without significant change.Multiple small foci of FLAIR hyperintensity in bilateral subcortical and periventricular white matter remain similar to prior exam and likely representing chronic small vessel ischemic strokes. Moderately enlarged supratentorial ventricular system and mild rightward negative shift of midline is present. This is an improvement compared to prior study which midline was deviated to the right more severely due to presence of subdurals.
1.No acute intracranial process.2.Stable postoperative changes of right anterior temporal lobectomy and extensive focus of nonenhancing cystic encephalomalacia and gliosis of right temporal lobe since prior exam.3.Interval near complete resolution of bilateral subdurals since prior study with resultant decreased midline shift.4.Interval expected evolution of left anterior frontal foci of contusion.5.Findings suggestive of chronic nonhemorrhagic small vessel ischemic strokes of mild degree.