73-year-old female with a history of posterior fossa GBM now with altered mental status. The exam is limited by motion. Again demonstrated are postsurgical changes of a prior suboccipital craniotomy for resection of posterior fossa tumor. The FLAIR hyperintensity in the cerebellar vermis and right greater than left cerebellar hemisphere surrounding the resection cavity are similar to the previous exam. The mass effect on the fourth ventricle is unchanged. There is mild restricted diffusion along the resection cavity without restricted diffusion elsewhere to suggest acute ischemic infarction. Contrast is not present and therefore assessment of contrast enhancement in the brain cannot be assessed.A nonspecific punctate focus of increased T2/FLAIR signal within the white matter adjacent to the frontal horn of the left lateral ventricle and within the bilateral medullary olives are unchanged. Stable mildly prominent lateral and third ventricles are likely related to volume loss. The basal cisterns remain patent. There is no midline shift. Normal flow-voids are demonstrated in the major intracranial vascular structures. Paranasal sinuses and mastoid air cells are clear.
Nondiagnostic exam for evaluation of contrast enhancement. The remainder of the findings in the posterior fossa are unchanged compared to the exam from 8/24/2016. The patient may return at no additional cost to repeat the post-contrast portion of the exam if deemed clinically warranted. The technologist was contacted to identify what happened to the contrast. Christina Sicker was paged at the time of this report to discuss the above issues related to contrast injection site. 