History of radiation and resection x2 of possible AVM, and then subsequent cavernomas, multiple bleeds: Bilateral weakness, right side numbness, gait problems, double vision, worsening over past several months. There are postoperative findings related to suboccipital craniotomy. There are multiple brainstem cavernous malformations. In particular, there has been interval decrease in size and internal T1 hyperintensity of the posterior left pontine cavernous malformation, now measuring up to 8 mm, previously 20 mm. The other cavernous malformations do not appear to have significantly changed in size, accounting for differences in technique. There are multiple prominent venous structures that course through the brainstem and left cerebellum. The supratentorial brain is unremarkable and there is no evidence of acute infarct. There is decreased effacement of het fourth ventricle and the third and lateral ventricles are not particularly dilated. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits are grossly unremarkable.
Multiple brainstem cavernous malformations. In particular, the posterior left pontine cavernous malformation has decreased in size with evolution of the internal hemorrhage, now measuring up to 8 mm, previously 20 mm. The other cavernous malformations do not appear to have significantly changed in size, accounting for differences in technique. Multiple prominent venous structures in the brainstem and left cerebellar region likely represent associated "developmental venous malformations". However, evaluation for residual arteriovenous malformation is limited and an angiographic examination may be useful, if clinically warranted.