 T1 and T2 hyperintense lesions are noted involving the right cerebellar hemisphere and vermis extending to the middle cerebellar peduncle and adjacent posterior lateral pons. Postcontrast images demonstrate multilobular, and multifocal enhancement of lesions involving the right cerebellar hemisphere, right middle cerebellar peduncle, the right posterolateral pons, as well as the left pontomedullary surface. The largest cerebellar focus of enhancement measures approximately 27 x 22 mm in axial dimension. These are associated with surrounding vasogenic edema. Additionally, there is nodular enhancement along the tentorium with additional enhancing nodules along the left anterior paramedian falx, involving the optic apparatus and adjacent inferior left rectus dry wrist, right occipital horn minimal surface, filling the right internal auditory canal, along the right occipital craniectomy site, and coating several cranial nerves..Craniotomy changes involving the right frontal bone near the convexity suggest the presence of a previous biopsy site.Redemonstrated is marked lateral and third ventricular enlargement with periventricular T2 hyperintensity suggesting transependymal flow. Although, white matter abnormality is diffuse, and there may also be a component of underlying treatment response.Susceptibility hypointensity is noted along a previous left frontal approach ventriculostomy catheter tract. Susceptibility also demonstrates tiny foci of hemorrhage within bilateral occipital horns.Fluid is again noted within the sphenoid sinuses and bilateral mastoid air cells. Expected vascular flow voids are demonstrated.
Extensive metastatic disease involving supratentorial and infratentorial brain, the intraventricular spaces, extra-axial CSF spaces, the dura, and the tentorium.