60 years Female (DOB:2/15/1956)Reason: assess for mets History: presumed metastatic breast cancerPROVIDER/ATTENDING NAME: JOHN F. MCCONVILLE JOHN F. MCCONVILLE There is a punctate focus of diffusion restriction present in the right occipital lobe subcortical white matter. Another focus of diffusion restriction is present in the right cerebellar hemisphere which is associated with T2 and FLAIR signal hyperintensity.There is diffuse thickening of the calvarium associated with the marrow replacement throughout the calvarium, skull base and visualized upper cervical spineThere is diffuse pachymeningeal thickening present.Punctate focus of susceptibility effect is present in the upper vermis. This associated with some contrast enhancement. Another punctate focus of susceptibility effect is present along the right marginal ramus of the cingulate sulcus. This is not seen on any other pulse sequences and is therefore nonspecific.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrates mucosal thickening in the right sphenoid sinus and scattered opacities in the ethmoid air cells. The visualized portions of the mastoid air cells demonstrate partial opacification. The visualized portions of the orbits are intact. The left eyelid appears distorted possibly related to tape closing the patient's eyelids. Patient is status post intubation..
1.Findings are compatible with diffuse calvarial, skull base and upper cervical spine metastases.2.There is diffuse pachymeningeal thickening present which is a nonspecific finding. One possibility is that it is a reaction to the patient's calvarial metastatic disease.3.A microhemorrhage within the vermis is a nonspecific finding. It's conceivable this represents a small cavernoma or other hemorrhagic lesion. A follow-up exam would help differentiate this from metastatic disease.4.Findings suggest microinfarcts in the right cerebellar hemisphere and of the right occipital lobe