posteriorly into the hippocampal body and tail, anteriorly to the temporal pole and uncus as well as hipoocampal head and amygdala, and superiorly to the inferior basal ganglia and insula, with surrounding edema predominantly in the left temporal lobe, and also extending
into the inferior left frontal lobe and subinsular white matter. Though difficult to measure given its infiltrative nature, it measures on the order of 4 x 6 cm in greatest transaxial dimension. There is mass effect with uncal and parahippocampal gyral herniation, abutting and displacing the left optic tract and effacing the left ambient and suprasellar cistern, abutting the midbrain with mass effect on the left cerebral peduncle. There is 2 to 3 mm midline shift. Mass demonstrates low signal on DWI. No enhancement postcontrast. It is associated with low perfusion on ASL and bolus perfusion. No evidence of hemorrhage. No acute infarct.
Ventricles and extra-axial spaces: No extra-axial collection or enhancement. Ventricular size is normal.
Visualized paranasal sinuses: Clear.
Mastoid air cells: Clear.
Additional comment: None.
1. Large nonenhancing infiltrative mass centered on the left medial temporal lobe, likely low-grade primary glial neoplasm though the surrounding edema is concerning, with local mass effect with uncal and parahippocampal herniation, and minimal (2 to 3 mm) midline shift.