Clinical question: Evaluate for intracranial hemorrhage. Signs and symptoms: Known brain metastases, increasing seizure frequency. Nonenhanced head CT:Examination demonstrates small foci of cortical increased density in the right anterior parietal and posterior frontal lobes, suspected for small hemorrhage/hemorrhagic tumor and or mineralization from prior treatment. The largest of these lesions measures 8.2 x 5.5 -mm in size. There are no prior exams for comparison.Examination also demonstrates fairly extensive periventricular and subcortical low attenuation of white matter with no apparent mass effect which may represent posttreatment changes / encephalomalacia / residual edema from metastatic brain lesions. There is a well demarcated area of CSF density in the left frontal lobe with apparent communication with the left frontal horn. This finding is under a left frontal craniotomy and may represent area of encephalomalacia/ surgical cavity. There is no evidence for midline shift or hydrocephalus. Ventricular system however is mildly dilated. Images through posterior fossa are unremarkable.Follow-up with an enhanced MRI is recommended.
Constellation of intracranial abnormalities as detailed above. Please see above comments.