Female, 60 years old, with weakness and confusion, history of pancreatic cancer now with multiple brain lesions, hemorrhage, possible aneurysm. MRI brain:At least 15 supratentorial masses are identified scattered through both cerebral hemispheres, and at least 4 masses are seen in the posterior fossa. All of these lesions enhance with some showing partial cystic morphology. Most demonstrate internal susceptibility compatible with blood product. The lesion within the suprasellar cistern noted on prior CT also represents a tumor nodule.The largest supratentorial lesions in the right temporal lobe and measures 39 x 35 mm. The largest lesion in the posterior fossa is in the left cerebellar hemisphere and measures 30 x 24 mm. The lesions are associated with variable mild to moderate edema and mass-effect. The right temporal lesion generates the most significant edema with associated effacement of the right lateral ventricle. The remaining ventricles are normal in size. No evidence of frank brain herniation is seen at this time.MRA brain:An inferiorly directed outpouching is seen arising from the distal left ICA, just before the terminus. This lesion measures 3 mm in length and up to 2 mm in width.No other aneurysms are suspected. No evidence of high-grade vascular stenosis or frank vascular occlusion is seen.
Numerous metastatic lesions are identified both supra- and infratentorially, some of which demonstrate internal cystic morphology. Most show evidence of tumoral blood product. These lesions elicit variable mild to moderate edema and mass effect.No suprasellar aneurysm is seen. The lesion in question on prior CT represents a tumor nodule. However, a 3 x 2 mm aneurysm is detected incidentally arising from the terminal left ICA.