Male, 62 years old, with history of GBM status post recent fall with pain in the lower back. Brain:Again seen is a rim-enhancing, centrally necrotic tumor in the right paramedian frontal lobe with evidence of biopsy. Since the prior examination, the overall size of the enhancing lesion has expanded and now measures 44 x 28 x 35 mm, previously 35 x 23 x 24 mm. Most of the enhancing rim correlates with elevated rCBV. T2 hyperintensity in the surrounding right frontal and parietal lobes is also significantly expanded with progressive regional sulcal effacement.Elsewhere, no new enhancing or nonenhancing lesions are identified. No evidence is seen to suggest acute intracranial hemorrhage or any abnormal extra-axial fluid collection. No acute ischemia is detected. Ventricles remain normal in size and morphology allowing for mild mass effect upon the right lateral ventricle.Lumbar:A compression deformity of the T12 vertebral body is seen with approximately 25% loss of vertebral body height. The marrow is edematous with reactive enhancement. No significant retropulsion is seen.The remaining vertebral bodies demonstrate preservation of height. No additional areas of edema or marrow replacement are seen. Spinal alignment is anatomic.The visualized distal spinal cord, conus and nerve roots of the cauda equina are within normal limits. No pathologic spinal cord or leptomeningeal enhancement is seen within the limitations of motion degraded images.Enhancement and mild edema is seen within the interspinous spaces of the lumbar spine. No obvious hematoma or fluid collection is seen.At L5-S1, there is a shallow central disc protrusion with annular fissuring but no significant spinal canal or foraminal stenosis. Elsewhere, the intervertebral discs are preserved.
1.Findings are seen concerning for interval progression of the right paramedian frontal lobe tumor. Treatment effect is a less likely consideration.2.A recent compression deformity of the T12 vertebral body is seen with approximately 25% loss of vertebral body height. No associated retropulsion or spinal canal stenosis is detected.3.Mild edema and enhancement within the interspinous spaces of the lumbar spine may represent soft tissue injury/ligamentous strain related to the patient's fall. However, it could also be an unrelated manifestation of interspinous impingement (Baastrup disease). 