Diagnosis: Secondary malignant neoplasm of brain and spinal cordClinical question: history of head and neck SCCa with single brain metastasis s/p resection and adjuvant SRS; surveillance MRISigns and Symptoms: brain metastases The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a punctate focus of diffusion restriction present at the right caudate nucleus new since prior exam. There is no associated contrast enhancement.Patient is status post left temporal craniotomy. There is some minor signal change present in the inferior aspect of the left temporal lobe measuring 8 x 10 mm axial dimensions which is associated with a low but of the susceptibility effect but no enhancement following gadolinium administration.No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. These are stable compared to the previous exam.There is a periventricular punctate focus of signal hypointensity in the right centrum semiovale on susceptibility weighted imaging which was also present on the prior exam and is unchanged.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. There is a developmental venous anomaly present in the left centrum semiovaleThe visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.
1.A small punctate lesion in the right caudate nucleus is suspected to most likely represent a microinfarct. A follow-up exam may be helpful to further evaluate this.2.Status post left temporal lobe surgery.3.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related. They are stable compared to the prior exam.