von Hippel-Lindau disease (VHL) with history of brain hemangioblastomas and prior intracranial surgery. Brain: There are postoperative findings related to right retrosigmoid craniotomy with a small extradural fluid along the inferior aspect of the mesh. There is a 3 mm diameter enhancing nodule in the left inferior cerebellar hemisphere with surrounding vasogenic edema. There is linear susceptibility effect along the cerebellar folia diffusely. There is scattered cerebral and pontine white matter punctate and confluent T2 hyperintensity, which may be related to chronic small vessel ischemic disease. There is no evidence of acute infarction. The lateral and third ventricles appear to be disproportionately prominent with respect to the sulci. The orbits are grossly unremarkable. Spine: The spinal cord displays normal signal and morphology. There are posterior disc-osteophyte complexes at C5-6 and C6-7 with mild spinal canal stenosis. There is also degenerative spondylosis at L3-4 and L4-5, where there is essentially mild bilateral neural foraminal and spinal canal stenosis. There is no significant spinal canal stenosis in the rest of the spine. Aside from areas of degenerative bone marrow signal alterations in the cervical and lumbar spine, the vertebral bone marrow signal is unremarkable. There are subcentimeter perineural cysts in the sacral spinal canal. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The paravertebral soft tissues are unremarkable. There are multiple bilateral renal cysts.
1. A 3 mm lesion in the left cerebellar hemisphere with surrounding vasogenic edema is compatible with a hemangioblastoma.2. Superficial siderosis involving the cerebellum.3. The lateral and third ventricles appear to be disproportionately prominent with respect to the sulci, which may represent normal pressure hydrocephalus. 4. No evidence of spinal cord lesions.5. Bilateral renal cysts, which can be more thoroughly assessed via dedicated imaging.