CNS lymphoma and lymphoplasmacytic lymphoma/Waldenstrom macroglobulinemia status post 4 cycles of MTR chemotherapy, now with new blindness. There has been interval progression of infiltrative abnormal enhancement involving the optic apparatus. In particular, there is now swelling and enhancement involving the intraorbital, canalicular, and prechiasmatic segments of the left optic nerve, as well as the canalicular and prechiasmatic segments of the right optic nerve and optic chiasm, right greater than left, with extension into the adjacent optic pathway. There is persistent swelling, but decreased enhancement of the left trigeminal nerve and persistent T2 hyperintensity in the left lateral pons along the course of the trigeminal nerve fibers, also without residual enhancement. There are also new subcentimeter areas of leptomeningeal enhancement along the right cerebellar tonsil and left cerebellomedullary junction region, as well as ependymal and subependymal enhancement in the right frontal horn. There are unchanged nonspecific foci of T2 hyperintensity without corresponding enhancement in the cerebral white matter. There is no evidence of acute infarction or intracranial hemorrhage. There is no significant interval change in the size of the ventricular system. There is no midline shift or herniation. The skull and scalp soft tissues are unremarkable. There is diffuse moderate paranasal sinus mucosal thickening. There is mild fluid signal within the mastoid air cells.
1. Interval progression of infiltrative abnormal enhancement involving the optic apparatus likely related to involvement by lymphoplasmacytic lymphoma. 2. New areas of leptomeningeal enhancement along the right cerebellar tonsil and left cerebellomedullary junction region, as well as ependymal and subependymal enhancement in the right frontal horn also likely represent involvement by lymphoplasmacytic lymphoma. 3. Persistent swelling, but decreased enhancement of the left trigeminal nerve also likely related to lymphoplasmacytic lymphoma. 4. Findings suggestive of sinusitis.