Metastatic tonsil squamous cell carcinoma to the brain status post resection and post-operative SRS: surveillance MRI. There are post-treatment findings in the left temporal region with minimal residual enhancement and confluent T2 hyperintensity in the left lateral temporal lobe. However, there are new 5 mm enhancing lesion sin the left occipital lobe and right precentral gyrus. There is a small area of high T2 signal and restricted diffusion in the right middle frontal gyrus. There are otherwise unchanged scattered nonenhancing foci of cerebral white matter T2 hyperintensity. There is an unchanged punctate focus of susceptibility effect in the right centrum semiovale. There is no evidence of intracranial hemorrhage or acute infarct. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, paranasal sinuses, and scalp soft tissues are grossly unremarkable.
1. Post-treatment findings in the left temporal region without evidence of measurable tumor.2. New subcentimeter lesions in the left occipital lobe and right precentral gyrus may represent metastases. 3. A small area of high T2 signal and restricted diffusion in the right middle frontal gyrus may represent a recent infarct. 