Diagnosis: Disorder of brain, unspecifiedClinical question: Preoperative planning for biopsy of intracranial massSigns and Symptoms: weakness There is a 17x20 mm axial dimension ring enhancing mass present in the left parietal lobe subcortical white matter. There is marked amount of vasogenic edema. There is mass effect associated with the vasogenic edema with compression of the right lateral ventricle and sulcal effacement There is a 9mm focus of contrast enhancement located in the posterior aspect of the left insular cortex.The ventricles are enlarged. There are periventricular confluent and patchy white matter T2 and FLAIR signal hyperintense lesions of a mild to moderate degree. There are patchy signal T2/FLAIR signal hyperintense foci in the brainstem.Normal vascular flow voids are present in the distal carotid arteries, the left vertebral artery, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus. The right vertebral artery flow void is not readily appreciated.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.
1.Examination was performed for purpose of stereotactic guidance during surgery. It is therefore limited exam. Overall there is no significant change when compared to the previous exam2.There is a left parietal lobe ring enhancing mass present associated with minor hemorrhage and diffusion restriction. Differential considerations include infection (abscess) as well as neoplasia (metastasis or possibly primary brain tumor).3.There is a hemorrhagic lesion along the posterior aspect of the left insular cortex.4.Marked ventriculomegaly. The possibility of normal pressure hydrocephalus cannot be excluded. Alternatively this could represent communicating hydrocephalus. 5.Periventricular and subcortical white matter signal changes are nonspecific. At this age they are most likely vascular related though they could be related to a neurodegenerative process such as nonspecific leukoencephalopathy of aging. 6.Lesions in the brainstem are most likely vascular related.