Metastatic lung cancer with diffuse bone metastases, on Nivolumab, now with blurred and double vision due to left lateral rectus palsy. There is an infiltrative enhancing lesion that measures up to approximately 3 cm involving the left aspect of the clivus, in the region of Dorello's canal. There is also a subcentimeter lesion in midline of the frontal bone. There are postoperative findings related to decompression of the upper cervical spine with an expansile mass involving C2 with indentation of the spinal cord. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is mild nonspecific scattered cerebral white matter T2 hyperintensity, as well as unchanged areas of encephalomalacia in the right perirolandic region and anterior right frontal lobe. There is no abnormal intracranial enhancement. 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 and scalp soft tissues are grossly unremarkable. There is mild mucosal thickening in the maxillary sinuses. There is also a small amount of fluid within the left mastoid air cells.
1. A lesion involving the left aspect of the clivus likely represents metastatic disease and may account for the double vision. Another subcentimeter lesion in the frontal bone also likely represents a metastasis. Otherwise, no evidence of intracranial metastases.2. Partially-imaged postoperative findings related to decompression of the upper cervical spine with a metastasis involving C2 with compression of the spinal cord. Discussed with Dr. Maitland at 3PM on 5/8/15.