Other complicated headache syndrome [G44.59] / Malignant neoplasm of unspecified part of unspecified bronchus or lung [C34.90], Reason for Study: ^Reason: brain mets History: severe headache, nausea, NSCLC w brain mets There is no evidence of acute ischemic or hemorrhagic lesion on the scan.Previously recognized right central sulcus leptomeningeal enhancement is not as conspicuous as before, but still demonstrated especially on sagittal scan (series 11, image #8/29).There are diffuse leptomeningeal enhancement involving bilateral occipital lobes, bilateral cerebellar hemispheres, vermis and the anterior aspect of pons indicating possible leptomeningeal metastatic lesions.The ventricles, sulci and cisterns are symmetric and unremarkable. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. Mucosal thickening on ethmoid sinuses and sphenoid sinus indicating sinusitis.In addition, there are some exaggerated leptomeningeal enhancement around cervical cord. This could represent extension of leptomeningeal metastatic lesion, thus, if clinically indicated, spinal MRI with and without contrast can be considered for further imaging evaluation.
1. Decreased but still remained right central sulcus leptomeningeal enhancement since prior scan.2. Extensive leptomeningeal enhancement involving bilateral occipital lobes, and posterior fossa as described above indicating leptomeningeal metastatic lesions.3. No acute hemorrhagic or ischemic lesion on the scan.4. Possible extension of leptomeningeal metastasis toward cervical spinal cord, if indicated, spinal MRI with and without contrast can be considered for further evaluation..