Clinical question: Metastatic melanoma, history of brain metastases, now with recent seizure and left-sided weakness. Evaluate for new brain metastases. Signs and symptoms: Recent seizure and left-sided weakness. Nonenhanced brain MRI:Only a single axial FLAIR sequence was obtained which at this point patient was unable to continue with the study and terminated the exam.Examination demonstrates a new focus of vasogenic edema in the right posterior frontal-parietal region containing acute blood products. Considering patient's history of malignancy this finding could represent a new focus of hemorrhagic metastatic lesion and follow-up with a complete exam is recommended.There is also a right posterior temporal hemorrhagic mass measuring approximately at 12 x 12 mm in transaxial dimensions and the sulcal surrounding vasogenic edema which is new since prior exam and consistent with a hemorrhagic metastatic lesion.A surgical cavity with CSF signal intensity in the left artery again posterior frontal and bit surrounding edema/FLAIR hyperintensity remain similar to prior exam.Focus of FLAIR hyperintensity and a cavity formation in the right frontal lobe at the site of previously known metastatic lesion is noted. Left posterior temporal-occipital vasogenic edema is at the site of a previously noted tiny metastatic lesion however lack of intravenous contrast precludes precise assessment for the size of underlying metastases.Mild prominence of lateral ventricles similar to prior exam however with interval decreased mass effect on the right frontal horn of lateral ventricle due to interval decreased vasogenic edema.
1.Incomplete exam due to patient's inability to continue and only a single axial FLAIR sequences acquired.2.New focus of hemorrhage and surrounding edema in the right posterior frontal-parietal suspicious for a new metastatic lesion.3.New focus of hemorrhagic metastases in the right posterior temporal suspected.4.Multiple additional foci of FLAIR hyperintensity consistent with patient's previously known tumors.5.Interval decreased vasogenic edema in the right frontal lobe with resultant decreased mass effect on the right frontal horn of lateral ventricle.