Reason: hemorrhage vs mets History: headache, aphasia There is a redemonstration of a hemorrhagic lesion involving the left inferior parietal lobule which is associated with heterogeneous enhancement in the region measuring approximately 37 by 34 mm axial dimensions and is associated with some adjacent leptomeningeal reaction.There is redemonstration of small foci of gyriform enhancement along the left postcentral gyrus and left middle frontal gyrus which have progressed when compared to the prior exam.There is a 5-mm left occipital lobe cortical based lesion which is also unchanged compared to the prior exam.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.Small T2 and flair punctate hyperintense lesions are present in the left thalamus and right basal ganglia.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.Findings are suspected to represent hemorrhagic conversion of ischemic infarction in the left parietal lobe and small foci of early chronic phase ischemic infarction involving involving left frontal, left parietal and left occipital lobes rather than metastatic disease . A follow-up exam in one or two months would help confirm this.2.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related. 3.Small lesions in the left thalamus and right basal ganglia are suspected to represent prior lacunar infarcts