New onset of dizziness and history of metastatic breast cancer. There is a heterogeneously enhancing mass with small areas of susceptibility effect in the right cerebellar hemisphere that measures up to 35 mm, with extensive surrounding edema and marked effacement of the fourth ventricle, as well as mild inferior cerebellar herniation. There is also a 5 mm wide left cerebellar hemisphere enhancing lesion with associated vasogenic edema. There is a punctate enhancing lesion at the grey white matter junction of the left posterior occipital lobe. There appears to be a small developmental venous anomaly in the left inferior frontal gyrus. There is dilatation of the third and lateral ventricle with diffuse periventricular T2 hyperintensity. There is no evidence of acute infarct. There is dilatation of the bilateral optic nerve sheaths, which attests to elevated intracranial cerebrospinal fluid pressure. The skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.
1. Bilateral cerebellar hemisphere metastases, right larger than left with extensive vasogenic edema associated with effacement of the fourth ventricle, acute obstructive hydrocephalus and mild inferior cerebellar herniation.2. A punctate enhancing lesion at the grey white matter junction of the left posterior occipital lobe likely represents a metastasis as well. Discussed with Dr. Nanda at 10:30 AM on 1/28/16.