Clinical question: Evaluate for progression of known GBM, new cranial nerve involvement. Signs and symptoms: Fossa bulge. Pre-and post-enhanced brain MRI:Diffusion weighted images demonstrate patchy irregular foci of restricted diffusion surrounding patient's known right hemispheric tumor.This finding is nearly identical to prior exam from January of 2015.Examination demonstrates post operative changes of a right-sided frontal -- temporal craniotomy and resection of a large segment of right anterior and mid temporal lobe similar to prior exam.A CSF signal intensity surgical cavity at the site of surgical resection remains identical in size and signal intensity to prior exam.Significant flair hyperintensity posterior to the surgical cavity in the right posterior temporal lobe and with extension to the right occipital lobe and splenium of corpus callosum with extension across the midline remain grossly identical to prior exam. There is no evidence of an acute new finding since prior study.Post enhanced images demonstrate a solid thick band of enhancement along the posterior edge of surgical cavity in the right posterior temporal lobe and extending along the medial aspect of the resection cavity along the medial aspect of left temporal lobe which demonstrate no appreciable change.Post enhanced images also demonstrate extensive nodular pattern of enhancement posterior to the surgical cavity in the right posterior temporal -- occipital region. Compared to prior exam there is increased nodularity of foci of enhancement. This observation could possibly be technique related. Ill-defined patchy enhancement of corpus callosum demonstrate no convincing evidence of change. Mild to moderately enlarged lateral ventricles (right greater than left demonstrate no significant change.There is no detectable foci of parenchymal signal abnormality or enhancement.
1.No convincing evidence of an acute or definite acute new finding since prior exam.2.Stable residual enhancing tumor in the right posterior temporal lobe with extension into the splenium of corpus callosum and along the medial aspect of left temporal lobe in signal intensity, extent, size and pattern of enhancement. Please see above comments.