Female, 65 years old, with altered mental status. Evaluate for worsening brain metastases and new ischemia. Evidence of a prior large resection is again seen involving portions of the left frontal and temporal lobes. Since the prior examination, thickened enhancing tissue surrounding the cavity on all sides has progressed. Pathologic enhancement extends up to and along the ependymal margin of the left lateral ventricle which is partially effaced similar to prior. Enhancement also extends up to the left temporal horn which is progressively effaced. Extensive confluent T2 hyperintensity is again seen involving the white matter of both cerebral hemispheres, more so on the left right. The geographic extent of this abnormal signal has progressed mildly at least within the left hemisphere. There is perhaps slightly increased left cerebral mass effect but only a 2 to 3 mm midline shift to the right. The left suprasellar cistern is partially effaced similar to prior. The quadrigeminal plate cistern remains patent.Progressive T2 hyperintensity is evident within the left cerebral peduncle. Also noted is new ill-defined ependymal enhancement along the right ventricular atrium and along the left posterior fourth ventricle.Signal abnormality compatible with an evolving hematoma is again seen along the floor of the left middle cranial fossa. No new acute intracranial hemorrhage is suspected. The caliber of the right lateral ventricle, third and fourth ventricles is similar to prior.
Findings compatible with progression of tumor are seen within the left cerebral hemisphere surrounding the previous resection site. Only mild increased mass effect is seen, however. Evidence of scattered new ependymal disease is also noted, for example at the right atrium and along the left posterior fourth ventricle, findings which may reflect dissemination via the CSF.