Clinical question: History of suprasellar meningioma status post resection and left frontal cystic mass. Signs and symptoms: Surveillance scan. Pre and post enhanced brain MRI:Negative diffusion weighted series.Examination redemonstrate stable postoperative changes of a right frontal and temporal craniotomy.Underlying right frontal focus of encephalomalacia and gliosis without detectable abnormal enhancement to suggest recurrence of tumor similar to prior exam.Also stable since prior exam is a round well-demarcated isointense T1 and mildly hyperintense on FLAIR and T2-weighted images and with a thick uniform rim of T2 hypointensity in the left paramedian floor of the anterior cranial fossa. The finding measures approximately 17 mm in transaxial dimensions similar to prior study. It demonstrate thick rim of enhancement similar to prior study. It applies regional mass effect on the left inferior frontal lobe without detectable surrounding edema or encephalomalacia. The finding is suggestive of a organized hematoma.There is no detectable associated bony abnormality with this finding an underlying ethmoid air cells and sphenoid sinus remain well pneumatized.Multiple scattered periventricular and subcortical foci of FLAIR hyperintensity without enhancement are again noted. Some of the lesions demonstrate perpendicular axis to the ventricular wall and also demonstrate a halo of T1 hyperintensity on axial nonenhanced T1-weighted images. The appearance of the findings are more suggestive of a demyelinating disease and less likely representing small vessel ischemic strokes.
1.Stable postoperative changes of a right frontal and anterior temporal craniotomy for removal of meningioma without detectable recurrence of tumor.2.Stable well demarcated extra axial mass like lesion along the floor of the left anterior cranial fossa with thick rim of enhancement suggestive of an organized hematoma. 3.Stable multiple nonenhancing foci of FLAIR hyperintensity several with morphology highly suggestive of demyelinating disease as detailed above. Unremarkable exam otherwise.