Rule out progression of metastatic brain disease: breakthrough seizures. There are new subcentimeter enhancing lesions in the superior left precentral gyrus and bilateral cerebellar hemispheres with a mild degree of vasogenic edema. In addition, two superior right cerebellar hemisphere lesions have increased in size. The other subcentimeter enhancing lesions within the inferior right cerebellar hemisphere, cerebellar vermis, and right parietal lobe have not significantly changed. There is also an unchanged subcentimeter enhancing lesion within the fundus of the right internal auditory canal. There are postoperative findings related to left parieto-occipital craniotomy without evidence of nodular enhancement to suggest tumor recurrence in this location. There is unchanged confluent white matter T2 hyperintensity at the treatment bed. There is an unchanged developmental venous anomaly in the brainstem associated with punctate foci of susceptibility effect that likely represent cavernous malformations. There is unchanged mild periventricular white matter T2 hyperintensity. There is unchanged mild encephalomalacia in the left cerebellar hemisphere. There is no evidence of acute infarct. The ventricles and basal cisterns are stable in size and configuration, with ex vacuo dilatation of the left lateral ventricle. There is minimal midline shift to the left. There is minimal fluid signal within the left mastoid air cells. There is mild mucosal thickening in the paranasal sinuses. The skull and extracranial soft tissues are unchanged.
1. New subcentimeter metastatic lesions in the superior left precentral gyrus and bilateral cerebellar hemispheres, as well as increase in size of right superior cerebellar hemisphere metastases. Other subcentimeter intracranial metastases have not significantly changed.2. Unchanged developmental venous anomaly in the brainstem associated with punctate foci of susceptibility effect that likely represent cavernous malformations.Discussed with JACOBSEN, JOHN at 10:55 AM on 11/5/15.