20 years Male (DOB:9/21/1996)Reason: Patient with CNS vasculitis to evaluate disease progression History: Follow upPROVIDER/ATTENDING NAME: KAREN B ONEL KAREN B ONEL The patient status post left parietal and right frontal craniotomies.There are multiple small foci of enhancement scattered in the left hemisphere the brain and to a lesser degree right hemisphere some which are associated with susceptibility effect negative of microhemorrhage. Included are basal ganglia bilaterally. The lesions predominantly in the left temporal and occipital lobes were also present in the frontal lobes, parietal lobes and temporal lobes and occipital lobes bilaterally.Some foci of encephalomalacia are redemonstrated in the left parietal lobe and the right parietal lobe and left occipital lobe.There is T2 and FLAIR signal hyperintensity present along the anterior aspect of the brainstem at the level of the medulla which was also present on the prior exam. This involves more the left than the right medulla. This is stable compared to the prior exam.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate an opacity in the right maxillary sinus. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. Couple nodules are redemonstrated in the left parotid gland and right parotid gland which could represent lymph nodes. It has not changed since the prior exam
1.Since the prior examination patient has developed multiple hemorrhagic lesions throughout both hemispheres but involving the left hemisphere more than the right and predominantly within the left temporal lobe and left occipital lobe. Given the patient's prior clinical history of CNS vasculitis. This can be explained on the basis. Contrast enhancement suggests that these could be in the subacute phase2.There is redemonstration of multiple foci of encephalomalacia in the left frontal lobe, left parietal lobe, right parietal lobe.3.There is redemonstration of a lesion within the medulla which is also stable compared to the prior exam.