 There are multiple, at least 10, supratentorial and infratentorial lesions with variable enhancement, many showing susceptibility effect consistent with hemorrhagic products, with variable surrounding confluent T2 hyperintensity. Aside from the calcified right hippocampus lesion, the lesions and associated edema are new from the prior MRI. Most of the larger lesions enhance irregularly along the periphery and are centrally necrotic. For example, a left cerebellar hemisphere lesion measures up to 6 mm, a left medial temporal lobe lesion measures up to 9 mm, a left temporal lobe lesion measures up to 11 mm, a left superior frontal gyrus lesion measures up to 12 mm, a right cuneus lesion measures up to 14 mm, and a right inferior parietal lobule lesion measures up to 19 mm. There is mild mass effect on the posterior horn and atrium of the lateral ventricles, right greater than left. However, there is no significant midline shift. There is a background of punctate T2 hyperintense signal abnormality scattered in the supratentorial periventricular and subcortical white matter which are nonspecific. There is no evidence of acute infarct. The orbits, skull, and scalp soft tissues appear unremarkable.
Multiple supratentorial and infratentorial metastases, many of which are hemorrhagic, but no evidence of acute infarct, midline shift, or herniation.Discussed with Dr. Lukas at 10:30 AM on 4/24/15.