61 years, Male, episodic left-sided tonic spasms of the face, arm, and leg right frontal cortex lesion seen on outside MRI.. There is an approximately 20 x 15 x 20 mm enhancing mass with associated expansion of the cortex of the posterior aspect of the right superior frontal gyrus abutting the falx. Previously enhancing nodule in this region measured 9 x 6 x 6 mm. Restricted diffusion was noted previously corresponding to the area which is now enhancing, with current study demonstrating more peripheral restricted diffusion. There is suggestion of increased central necrosis. There is also increase in adjacent leptomeningeal enhancement along the right paracentral lobule. There is associated mild vasogenic edema which is not significantly changed. There is minimal susceptibility within this lesion may represent minimal blood products or mineralization. No other mass or abnormal parenchymal or meningeal enhancement is appreciated elsewhere in the brain. Prominent perivascular spaces are incidentally noted in the left subinsular region and left temporal stem. No hydrocephalus or extra-axial collections. No evidence of midline shift or herniation. Calvarium and extra cranial soft tissues are unremarkable.
There is an enhancing mass involving the posterior aspect of the superior frontal gyrus which compared to 12/31/2015 demonstrates increased enhancement and central necrosis. There is also new adjacent leptomeningeal enhancement. Relatively mild surrounding edema is not significantly changed. Differentials include high-grade glioma, atypical infection, and less likely metastatic disease.