Follow up of enhancing lesions in the brain. There is no significant interval change in the areas of subcortical white matter T2 hyperintensity with a component of enhancement and mild volume loss rather than mass-effect, within the anterior right temporal lobe, although this appears to be less extensive than in 2012. Likewise, a subcentimeter focus of high T2 signal and enhancement in the left frontal lobe white periventricular matter is unchanged since the last exam and slightly smaller than in 2012. There are also unchanged patchy areas of high T2 signal elsewhere in the cerebral white matter without associated enhancement. There are scattered areas of susceptibility effect in the supratentorial sulci, particularly the right frontal lobe. There is no evidence of acute infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. There are bilateral lens implants.
1. No significant interval change in the areas of subcortical white matter T2 hyperintensity with a component of enhancement, but no mass-effect, within the anterior right temporal lobe, although this appears to be less extensive than in 2012. Likewise, a subcentimeter focus of high T2 signal and enhancement in the left frontal lobe white periventricular matter is unchanged since the last exam and slightly smaller than in 2012. These lesions may represent the sequela of inflammatory process, including a paraneoplastic syndrome, or vasculitis process rather than neoplasm.2. Unchanged nonspecific patchy areas of high T2 signal elsewhere in the cerebral white matter without associated enhancement, which may represent chronic small vessel ischemic disease and/or additional areas of a prior inflammatory process. 3. Redemonstration of scattered areas of supratentorial superficial siderosis, which may be related to a previous vasculitis process. An angiographic exam may be useful for follow up.