 Redemonstrated is an intraparenchymal hematoma centered within the right parietal lobe with extensive edema. Postcontrast images reveal an enhancing nodular component anteriorly measuring up to 32 x 17 mm in transverse dimension, as well as a collection of enhancing foci posteriorly (the largest of which measures up to 15 x 15 mm). The collection of hemorrhage, enhancing material, and edema measures approximately 8 x 8 x 8 cm. Significant mass effect includes leftward midline shift measuring 22 mm, right uncal herniation, deformation of the midbrain and pons, and downward transtentorial herniation. Also redemonstrated is a subdural fluid collection along the right frontal convexity which appears to contain a nonenhancing curvilinear (perhaps membranous) component measuring up to 11 mm in thickness which is overall slightly more T1 hyperintense than CSF, T2 hyperintense, and CT hypodense, most suggestive of proteinaceous material within a collection of CSF. As before, there is dilatation of the right temporal horn compatible with trapped ventricle and dilatation of the left lateral ventricle compatible with developing obstructive hydrocephalus.
Large 8-cm space-occupying lesion centered within the right parietal lobe containing hemorrhagic components, enhancing material, and edema. Given the patient history of neuroblastoma, this is most consistent with a heterogeneous hemorrhagic metastasis from neuroblastoma. Significant associated mass effect with herniations as well as a right frontal subdural primarily fluid collection are described in detail above.