Clinical question: New parietal brain lesion, history of metastases. Signs and symptoms: AMS. Pre- and post enhanced brain MRI: Examination demonstrates a focus of restricted diffusion consistent with a subacute ischemic stroke in the left posterior temporal-parietal region. It demonstrate subtle gyriform enhancement which is unexpected finding in a subacute stroke. The finding results in effacement of adjacent cortical sulci.This examination demonstrate no convincing evidence of any metastatic lesion.Chronic postoperative changes (large area of encephalomalacia) of a right frontal parietal craniotomy is noted without detectable abnormal enhancement.Diffuse uniform FLAIR hyperintensity of bilateral hemispheric white matter highly suggestive of posttreatment/radiation changes. There is ex vacuo dilatation of supratentorial ventricular system however maintained midline. Diffuse patchy foci of FLAIR hyperintensity in the pons could also represent posttreatment changes or chronic small vessel ischemic strokes.Unremarkable calvarium and soft tissues of the scalp as well as orbits and without abnormal enhancement.
1.Subacute left MCA ischemic stroke with expected gyriform cortical enhancement in the left posterior temporal and parietal with regional mass effect.2.No evidence of residual or recurrence of metastatic disease.3.Extensive chronic postoperative changes of the right sided craniotomy.4.Diffuse FLAIR hyperintensity of bilateral hemispheric white matter and pons representing post treatment/radiation change however overlapping chronic small vessel ischemic strokes cannot be excluded.5.Ex vacuo dilatation of supratentorial ventricular system secondary to underlying parenchymal volume loss.