Reason: blinotumomab toxicity? CNS involvement of ALL? History: expressive dysphasia, ALL The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.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 are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.Exam is somewhat compromised by patient motion.
1.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related. This is stable compared to the November exam.2.Exam is somewhat compromised by patient motion which may obscure more subtle abnormalities.