Metastatic breast cancer with new diagnosis of Bell's palsy. Evaluate for leptomeningeal disease. There is asymmetrically diffuse, mild, smooth enhancement along much of the left facial nerve. There is no evidence of intraparenchymal hemorrhage, mass, or acute infarct. There a numerous scattered, non-enhancing, punctate foci of T2 hyperintensity in the cerebral white matter. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, paranasal sinuses, and scalp soft tissues are grossly unremarkable. The bone marrow of skull and upper cervical spine is heterogeneous with diffuse areas of T1 and T2 hypointensity, but the cortical margins appear to be intact.
1. The appearance of enhancement along the left facial nerve is compatible with an inflammatory neuritis, such as Bell's palsy, rather than metastatic disease. Nevertheless, follow up to resolution of this abnormality is recommended.2. No evidence of intraparenchymal hemorrhage, mass, or acute infarct. 3. Mild probable chronic white matter small vessel ischemic disease.4. The appearance of the imaged bone marrow is suggestive of an infiltrative process such as metastatic disease.