Other malignant neoplasm without specification of site [199.1], Reason for Study: ^Reason: 21 y/o with h/o metastatic testicular cancer to brain and lung. c/f brain metastasis as well as hemorrhage into metastasis vs. Leptomeningeal disease. Brain MRIThere is subacute hemorrhagic foci on the right precentral gyrus cortex which shows some enhancement with minimal surrounding edema. Considering the patient's clinical history of malignancy, this lesion could represent hemorrhagic metastasis.There are multiple enhancing lesions on the right posterior medulla and right inferoanterior aspect of cerebellar hemisphere, again indicating metastatic lesions.There is no evidence of acute ischemic lesion on this scan.There is no evidence of abnormal leptomeningeal enhancement.The ventricles, sulci and cisterns are symmetric and unremarkable. The midline structures and cranial-cervical junction are normal. The paranasal sinuses and mastoid air cells are clear.Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate normal ICAs, MCAs and ACAs. Vertebrobasilar system appears to be normal.Neck MRA3D MRA neck post-gadolinium images with maximum intensity projections of the cervical vasculature demonstrate non visualization of the right vertebral artery from the level of C34. Considering the size of proximal right vertebral artery and tapering fashion of the distal visualized portion of the right vertebral artery, arterial dissection can be a differential diagnosis. Axial fat saturation T1 scan of the neck shows intra-luminal high signal intensity on the right vertebral artery which suggest possible intraluminal thrombus or very slow flow. However, due to motion artifacts and low spatial resolution, evaluation of vertebral arterial wall hematoma which could be diagnostic for the possibility of arterial dissection cannot be precisely evaluated.Otherwise, normal flow enhancement in a normal aortic arch origin of the right brachiocephalic, left common carotid, and left subclavian arteries were seen. Bilateral vertebral artery origins are normal. There is normal flow enhancement through the bilateral common carotid, carotid bifurcations, internal/external carotid, and vertebral arteries. There are multiple lung lesions demonstrated. The largest lesion is on the right upper lung and the size was 21mm.Orbit MRIThe globes, optic nerves, extraocular muscles and retroglobal spaces are symmetric and normal. The lacrimal glands are normal. There is no evidence of signal abnormality, mass, or abnormal contrast enhancement.
1. Multiple metastatic lesions including the right frontal lobe pre central gyrus (hemorrhagic), right posterior medulla and right cerebellar hemisphere.2. No acute ischemic lesion. No abnormal leptomeningeal enhancement.3. Non visualization of right vertebral artery indicating right vertebral artery occlusion. 4. Normal brain MRA. Normal Orbit MRI. 