Reason: Is there a stroke or metastatic lesion? History: altered mental status in lung cancer patient There is significant motion artifact present which may obscure subtle abnormalities. Faster sequences were used.No foci of diffusion restriction are identified in the brain parenchyma.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.Incidental note is made of a developmental venous anomaly along the medial aspect of the right parietal lobeBiventricular diameter is 43 mm and previously was the same. They are slightly large. In 2010 it was 36 mm.SWI images are suboptimal . A previously noted right temporal lobe microhemorrhage cannot be evaluated on the current exam.No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.
1.The ventricles are disproportionally large compared to the sulci (they have enlarged since 2010). The possibility of normal pressure hydrocephalus cannot be excluded.2.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related. 3.There is no evidence for acute ischemic cerebral infarction.4.To the extent of visualization no brain metastases are appreciated.5.There is significant motion artifact present which may obscure subtle abnormalities. Faster sequences were used which are not as sensitive as conventional sequences.