Altered mental status. There is a rounded T2 hyperintense subcentimeter lesion in the left hippocampus that corresponds to the hyperattenuating lesion demonstrated on CT. There are also nonspecific mild scattered foci of cerebral white matter T2 hyperintensity. There is no evidence of intracranial hemorrhage or acute infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. However, there is an incompletely imaged C4 vertebral lesion. There is fluid in the bilateral ethmoid sinuses.
1. A subcentimeter lesion in the left hippocampus may represent metastatic disease, although assessment is limited due to the lack of intravenous contrast. 2. Incompletely imaged C4 vertebral metastasis.