Metastatic NSCLC to bone with new symptoms concerning for brain metastases. There are multiple, at least 10, supratentorial and infratentorial intraparenchymal and leptomeningeal enhancing lesions. For example, a heterogeneously enhancing dominant tumor with central foci of susceptibility effect in the left thalamic region with focal effacement of the third and lateral ventricles measures up to 36 mm, an irregular right anterior superior frontal gyrus lesion measures up to 11 mm, a peripherally enhancing left lateral orbitofrontal gyrus lesion measures 8 mm in diameter, an enhancing nodular along the superior vermis measures 6 mm in diameter, an enhancing focus in the interpeduncular cistern measures 4 mm in diameter, a focus of enhancement along the ependymal margin of the left occipital horn measures 4 mm, and there are enhancing foci along multiple cranial nerves. Many of the lesions are associated with vasogenic edema. There is an enhancing 5 mm wide left frontal convexity lesion without substantial mass effect upon the underlying brain parenchyma. There is a background of nonspecific mild scattered cerebral white matter T2 hyperintensity without associated enhancement. There is no evidence of intracranial hemorrhage or acute infarct. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.
1. Multiple supratentorial and infratentorial intraparenchymal and leptomeningeal metastases, with a dominant left thalamic region tumor that measures up to 36 mm and may contain small areas of hemorrhage.2. A 5 mm wide left frontal convexity lesion may represent a meningioma.