Months of right lower extremity and right upper extremity muscle spasm and contraction. Brain: Again seen are postsurgical changes related to prior left parietal parasagittal meningioma resection. There has been interval development of a 2.1 x 2.2 x 2.4 cm lesion involving the left paracentral lobule with susceptibility effect and focus of T1 hyperintensity indicating subacute hemorrhage. There is heterogeneous enhancement associated with this lesion. There is interval increase in surrounding FLAIR hyperintensity consistent with vasogenic edema. Prior study demonstrated a subcentimeter enhancing nodule in this region which appears to be present along the posterior aspect of this lesion and minimally more prominent. No abnormal parenchymal or meningeal enhancement is seen elsewhere in the brain. Several foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with mild chronic small vessel ischemic changes. Mild cerebellar tonsillar ectopia is again seen. No evidence of acute ischemia. No extra-axial collections. No hydrocephalus. Major flow-voids are preserved. Complete spine:CERVICAL SPINE
1. Postoperative changes related to left parietal meningioma resection are again seen. Compared to 3/15/2016, there has been interval development of a 2.4 cm heterogeneously enhancing hemorrhagic lesion in the left paracentral lobule treatment bed with increase in surrounding edema. A nonspecific subcentimeter enhancing nodule which was present previously is again seen and is minimally more prominent; this nodule is just posterior to the new hemorrhage/hemorrhagic lesion. A relatively rapidly enlarging, recurrent meningioma does not seem likely although the etiology of the new hemorrhage is unclear. 2. No high-grade spinal canal stenosis or cord signal abnormality in the spine. No abnormal enhancing lesions.3. Degenerative changes in the cervical spine with mild to moderate spinal canal stenosis at the C4-C5 and C5-C6 levels. There is also a disc extrusion at the L2-L3 level. Additional details as above.