Evidence of stroke or metastasis: Altered mental status. There are several punctate foci of restricted diffusion and high T2 signal in the bilateral cerebral and cerebellar hemisphere watershed zones, without evidence of associated hemorrhage or enhancement. There are postoperative findings related to left parietal craniotomy, with intrinsically T1 hyperintense material within the resection cavity and patchy enhancement along the margins of the cavity. There is a 5 mm diameter enhancing lesion in the right anterior cingulate gyrus and a 4 mm diameter enhancing lesion in the right superior frontal gyrus. There is a background of scattered cerebral white matter high T2 signal without enhancement or restricted diffusion, which may represent chronic small vessel ischemic disease. 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 are grossly unremarkable. There is fluid signal in the mastoid air cells.
1. Multiple punctate recent infarcts in the bilateral cerebral and cerebellar hemisphere watershed zones, without evidence of associated hemorrhage.2. Postoperative findings related to left parietal craniotomy, without definite evidence of gross residual tumor in this location.3. Subcentimeter enhancing lesions in the right anterior cingulate gyrus and right superior frontal gyrus are compatible with metastases. Discussed with Dr. Gajewski at 11 AM on 8/7/15.