56-year-old male with brain lesions. Redemonstrated is a medial left cerebellar enhancing lesion that measures up to 18 mm, a left lateral cerebellar enhancing lesions that measures up to 10 mm, a medial right cerebellum enhancing lesion that measures up to 4 mm, and a left middle frontal gyrus enhancing lesion that measures up to 9 mm, are unchanged in appearance. A left superior frontal gyrus lesion and a left hippocampal tail enhancing lesion, demonstrated previously, are not apparent on the current study perhaps secondary to timing of acquisition. As before, there is confluent T2 hyperintensity surrounding the larger lesions, which is decreased involving the cerebellum. There are no new lesions. Partial effacement of the fourth ventricle has resolved. There is no midline shift or herniation. There is mild scattered subcortical and confluent periventricular white matter T2 hyperintensity without associated enhancement. The major cerebral flow voids are intact. The orbits are grossly unremarkable. There is a subcentimeter exophytic cystic lesion in the skin along the left lateral eyelid region, which may represent a hidrocystoma, unchanged in appearance. There is a stable apical scalp lipoma that measures 7 mm in thickness. Redemonstrated are small bilateral maxillary sinus retention cysts.
Multiple supratentorial and infratentorial metastases with vasogenic edema, some of which appear less conspicuous which may be related to a timing of acquisition phenomenon. Edema and mass effect within the posterior fossa has decreased, with resolution of previously demonstrated fourth ventricular partial effacement.