Altered mental status, hemorrhagic brain metastasis. Redemonstration of 2 parenchymal hemorrhagic foci including left caudate body and right occipital lobe with evidence of gadolinium enhancement. These lesions show MR evidence of localized surrounding edema.There is no other enhancing lesion is seen. On FLAIR images, there is a focal high signal intensity lesion on the right side of caudate splenium without evidence of Gad enhancement nor evidence of hemorrhage. Since the lesion shows low signal intensity on T1, this lesion may represent prior small tissue defects possibly related to lacunar infarction.There is a suspicious focal tissue defect (myelomalacia) on spinal cord at the level of C12 level (series 1201, image 17/33) with subtle adjacent enhancement. The enhancement could be related to partial volume averaging artifacts from epidural venous plexus. However, considering the patient's other intracranial enhancing lesions, if clinically indicated, dedicated cervical spine MRI with and without contrast can be considered for further evaluation.The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.
1. Two intra axial hemorrhagic foci with enhancement as described above likely representing metastatic foci than simple intracranial hemorrhages.2. No other abnormal enhancement is seen.3. Suspicious C12 level cervical cord lesion as described above, if clinically indicated, dedicated cervical spine with and without contrast enhancement can be considered.