Clinical question: Evaluate for changes in MRI (? Evolving CVA versus metastases). Signs and symptoms: Abnormal brain MRI. History of extra CNS breast cancer. Pre and post enhanced brain MRI:Negative diffusion weighted series.Examination demonstrates interval resolution of hematoma in the left posterior temporal and parietal region with resultant resolution of subtle associated mass effect. There is resultant development of hemorrhagic encephalomalacia and with mineralization of overlapping cortex at this site. Mild interval increased size of left trigone of the lateral ventricle is also noted. There is no mild linear enhancement of the cortex at the site is present. Findings are consistent with a previously known hemorrhagic ischemic stroke and without no evidence of metastatic lesion of the brain parenchyma or the leptomeninges. Calvarium also demonstrates normal signal intensity without detectable abnormal enhancement.Diffuse periventricular and a left frontal cortical foci of FLAIR hyperintensity consistent with chronic small vessel ischemic strokes and a left frontal chronic cortical stroke remains similar to prior exam.Unremarkable images through the orbits and including axial fat sat post enhanced series.Normal signal intensity of all paranasal sinuses and bilateral mastoid air cells and middle ear cavities.
1.Interval complete resolution of left posterior temporal-parietal hemorrhage with resultant development of regional hemorrhagic encephalomalacia.2.No evidence of parenchymal, leptomeningeal or calvarial metastatic lesions.3.Negative diffusion weighted images extensive chronic small vessel ischemic strokes and chronic left frontal ischemic stroke.