71 years Male (DOB:10/19/1944)Reason: Hx of head and neck cancer with altered mental status R/o brain mets Vs infarct History: altered mental statusPROVIDER/ATTENDING NAME: ANUBHA C GANJOO ANUBHA C GANJOO There is a small focus of diffusion restriction present in the left para hippocampal gyrus posteriorly measuring approximately 7 mm in diameter. This is also somewhat hyperintense on T2 and FLAIR imaging.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.There is T2 and FLAIR signal hyperintensity present along the anterior aspect of the right inferior frontal gyrus associated volume loss. The patient is status post right-sided craniotomy.There is a focus of signal hypointensity on susceptibility imaging in the right insular cortex which is low signal on T2. It measures approximate 9 mm on T2 imaging.Another T2 hypointense focus is present in the left cerebellar hemisphere along the inferior semilunar lobule associated with susceptibility effect.There is a T2 hypointense lesions present in the right cerebellar hemisphere which has some susceptibility effectPunctate focus of signal loss and susceptibility weighted imaging is present in the left inferior parietal lobule and another in the left superior frontal gyrus.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. The middle cerebral artery vasculature appears rather ectatic. The basilar artery also appears somewhat ectaticThe visualized portions of the paranasal sinuses demonstrate partial opacification of the left maxillary sinus. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.
1.Hemorrhagic appearing focus is present in the right insular cortex and external capsule associated with adjacent edema. The possibility this represents hemorrhagic metastasis cannot be excluded given the patient has known primary lesion elsewhere. Another possibility is that this may represent an aneurysm or cavernous malformation. If clinically appropriate a CT angiogram of the brain may be of further benefit to evaluate this.2.There is a very small hemorrhagic lesion in the right and left cerebellar hemisphere as well as a couple smaller hemorrhagic lesions in the left frontal lobe and left parietal lobe. The possibility this represents metastatic disease cannot be excluded.3.There are small lesions present in the left parahippocampal gyrus. Although this could very well represent a subacute infarction, this is a relatively unusual location for cerebral infarction, the signal characteristics are not very convincing and there is local volume loss. As a result a different type of pathology may be present here.4.Findings suggest encephalomalacia along the right prefrontal artery territory. This could be a result of prior vascular event5.Please note that contrast-enhanced exams or more sensitive in detection of brain metastases.6.The patient status post right-sided craniotomy.