Small lung cancer with brain metastasis. Confusion and slurred speech. The numerous contrast-enhancing lesions which are predominantly distributed along the cortical surface have progressed since the previous examination, as well as the vasogenic edema associated with some of the lesions. The lesions are most coalescent along the left sylvian fissure, where they are also associated with increased subjacent vasogenic edema and slight mass-effect on the adjacent structures. For example, one of these lesions now measures transaxially 2.4 cm x 1.8 cm compared to 2.0 cm x 1.0 cm previously. Some of the lesions in the occipital lobes are not clearly appreciated on prior and may be new. There is no midline shift or brain herniation. The lesions are associated with mild diffusion restriction, probably reflecting their dense cellularity. The nonspecific periventricular T2/or hyperintense signal in both cerebral hemispheres remain unchanged and probably reflect a combination of microvascular ischemia and treatment effect.The orbits are grossly unremarkable. There is no destructive skull lesion.
1.Since previous MRI of March 2016, there has been progression of intracranial metastatic disease with enlargement of numerous intraparenchymal lesions which are predominantly along the cortical surface. There is also mild increase in the associated vasogenic edema, particularly in the left insular region. There is no midline shift or herniation.2.Unchanged periventricular cerebral white-matter T2-hyperintensity probably represents chronic microvascular ischemia and treatment effect. 