57-year-old male with a history of multiple skin cancers presents with a vocal cord paralysis. There are postoperative findings related to left left lateral temporal bone resection with myocutaneous graft reconstruction. There has been interval increase in the degree of a peripherally enhancing area with scattered foci of susceptibility effect and surrounding edema in the left temporal lobe with effacement of the third and left lateral ventricles, but dilatation of the right lateral ventricle. The defect in the left tegmen with mild herniation of the inferior temporal lobe is unchanged. There is minimal residual fluid extra-axial fluid along the floor of the left middle cranial fossa. There is no evidence of acute territorial infarction. There is a nonspecific punctate focus of susceptibility effect in the right anterior cingulate gyrus. There are denervation changes in the left masticator and facial expression muscles. Low T1 and T2 bone marrow signal in the irregular left mandibular condyle may be attributed to degenerative changes with subchondral sclerosis. There has been interval resolution of the enhancement in the left cochlea and cranial nerves in the left internal auditory canal, but new T1 hyperintensity in the left vestibule and semicircular canal.
1. Continued evolution of what likely radiation necrosis in the left temporal lobe with increase in localized mass effect and incipient obstructive hydrocephalus of the right lateral ventricle.2. Persistent defect in the left tegmen with mild herniation of the inferior temporal lobe and minimal residual extra-axial fluid collection along the floor of the left middle cranial fossa.3. Resolved enhancement of the left cochlea and cranial nerves in the left internal auditory canal, but new T1 hyperintensity in the left vestibule and semicircular canal, which may be related to proteinaceous debris or hemorrhage.