Large intraaxial mass at right temporo-parietal junction. It measures 5.7 x 5.4 x 4.8cm is largely cystic/necrotic, has ring enhancement and solid heterogenous enhancement posteroinferioly measuring 3.6 x 1.8 x 1.1cm. It extends to the subependyma of trigone and posterior temporal horn. Bright FLAIR signal extends into right anterior temporal pole and internal capsule posterior limb as well as the overlying cortex. Diffusion restriction and increased CBV of the thin enhancing rim and solid component. MRS suboptimal but shows increased choline at the margin (despite elevated baseline) and centre shows increased lactate.
There is transtentorial herniation with midbrain distortion. Midline shift to left 1.3cm.
Scattered foci of bright FLAIR signal in the rest of white matter (centrum semiovale) and periventricular deep white matter probably reflect chronic small vessel ischaemia.
Conclusion : Right temporoparietal lesion, with overall findings favouring a cystic high grade glioma.