Diagnosis: Unspecified convulsions Unspecified convulsionsClinical question: Evaluate for possible new metastatic lesionSigns and Symptoms: New onset seizures, known brain mets There is redemonstration of multiple enhancing lesions in both hemispheres of the brain as well as the cerebellum most of which are associated with susceptibility effect. Compared to the prior exam from July, there has been some interval change. One in the left periventricular white matter which ring-enhancing and previously measured 21 x 13 mm axial dimensions now measures 15 x 11. One in the anterior aspect of the left frontal lobe previously measuring 23 x 15 mm now measures 25 x 18 mm. One in the left inferior parietal lobule has also increased in size and measures 10 mm axial dimensions whereas it previously measured 7 mm axial dimension. A right temporal lobe lesion currently measures 19 x 10 mm and previously measured 17 x 13 mm. One in the left cerebellar hemisphere previously measured 13 mm and now measures 19 mm. One in the right cerebellar hemisphere measures 8 mm and now measures 15 mm. Since the prior exam diffuse periventricular confluent white matter T2 and FLAIR signal hyperintensity has progressed.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate mucosal thickening in the right maxillary sinus and right ethmoid air cells. There are is partial opacification of the right sphenoid sinus. The visualized portions of the mastoid air cells are partially opacified. The visualized portions of the orbits are intact.
1.Since prior examination multiple hemorrhagic brain parenchymal lesions compatible with metastases have overall increased in size and number.2.Since prior exam T2 and FLAIR signal hyperintensity involving the white matter has progressed. Most likely this white matter signal change is treatment related.