PATIENT NAME: POLISHCHUK, Katherine
EXAM DATE:
11/18/2005
DOB 12/15/2000
ORDER PROVIDER: FELDMAN, DANIEL
PCP Provider: Feldman, Daniel
EXAMINATION: MRI BRAIN WITHOUT AND WITH CONTRAST
MRI BRAIN WITHOUT AND WITH CONTRAST
IMPRESSION:
1.
Brainstem tumor consistent with brainstem glioma. In axial cross-section
this process is not much bulkier, but it appears to be
pushing the fourth ventricle more posteriorly, and there is now
some cerebellar tonsilar herniation.
2.
Interval development of hydrocephalus and cerebellar tonsilar descent.
3.
The amount of staining post-gadolinium has increased.
INDICATION: Brainstem glioma follow-up.
COMPARISON: August 11 and September 15, 2005.
This study is performed on an emergency basis at the request of
Dr. Bradshaw and the physician taking care of this patient at OHSU.
TECHNIQUE:
Using our conscious sedation protocol with nurse monitoring, we sedated the
patient with 50 mg of Nembutal. A magnetic resonance imager was used to
obtain multi-planar T1, T2 and spin density weighted images before contrast.
Multiplanar T1-weighted images following the injection of IV gadolinium 3cc.
FINDINGS:
The September study demonstrates a large pontine tumor, which in the interim
had developed some staining post-gadolinium. in the far left lateral
aspect. The patient is developing some ventriculomegaly on today's study
and there is some subependymal CSF resorption noted. We measured the
process at the internal auditory canals. It is unchanged in
cross-sectional diameter at 30 x 50 mm, compared to 31 x 48 mm on the
previous study in September. The developing hydrocephalus is a little bit
difficult to explain. The aqueduct is open. It may be that egress of CSF
from the fourth ventricle is being compromised. The process now extends
more anteriorly in the direction of the clivus. The distance from the
anterior aspect of the tumor to the floor of the fourth ventricle is 38.7
mm now, compared to 28.5 mm previously. No diffusion restriction. The
amount of enhancement post-gadolinium has increased. This enhancement is
irregular in contour and somewhat difficult to measure but is no the
order now of 25 x 13 mm, compared to 10 x 12 mm previously. No
supratentorial staining. No evidence of CSF seeding. Paranasal sinuses and
orbits are normal. Flow voids demonstrated in vertebral basilar and
internal carotid arteries.