Altered mental status and right upper extremity abnormal movement. History of metastatic high grade serous papillary ovarian carcinoma; status post 6 different lines of therapy. Assess for stroke or new metastasis. The examination is at least mildly limited by motion, which is most pronounced on the postcontrast brain MRI sequences and the cranial MRA.BRAIN MRI:There are changes of previous metastasectomy in the posterior right frontal lobe with underlying T2 FLAIR hyperintense signal and susceptibility, which may reflect associated gliosis and chronic blood products. There is a punctate focus of diffusion restriction involving the lateral image of the left hippocampus, abutting the temporal horn. There is no other focus of diffusion restriction. There is no contrast enhancing or space-occupying brain lesion. Punctate T2-hyperintense foci in the cerebral white-matter, predominantly frontoparietal, are nonspecific but may reflect chronic microvascular ischemia. The ventricles and other CSF-containing spaces are mildly enlarged, reflecting mild global brain volume loss. A partially empty sella might be an incidental finding at this age.There is no destructive skull lesion, accounting for the small craniotomy near the vertex. There are changes of bilateral eye lens replacement. The mastoid air cells are clear.CRANIAL MRA:There is no significant stenosis in the intracranial anterior or posterior circulations. Minimal contour irregularity is seen such as at the right P1 and left M1 segments and may reflect mild atherosclerotic narrowing or artifact.
1.There is punctate diffusion restriction in the left hippocampus which may be related to acute ischemia or seizure and can be seen with entities such as transient global amnesia. There is however no large vascular territory infarct. 2.There are postsurgical changes related to resection of lesion in the posterior right frontal lobe with adjacent gliosis and chronic blood products. No enhancing lesions are seen in the brain to suggest metastatic disease. Note however that post gadolinium images are motion degraded which may limit sensitivity for detection of small lesions.3.Nonspecific changes related to mild chronic microvascular ischemia and/or treatment.4.No significant steno-occlusive intracranial arterial lesion.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.