Breast cancer metastasized to central nervous system. There is increase in size of a left inferior temporal lobe enhancing nodule, measuring up to 4 mm, previously 2 mm, and a left middle frontal gyrus lesion, measures up to 7 mm, previously 5 mm. There is no significant interval change in the other extensive supratentorial and infratentorial metastatic disease. There is vasogenic edema associated with the lesions, but otherwise an unchanged background of mild periventricular white matter T2 hyperintensity, which may represent chronic small vessel ischemic disease. There are postoperative findings related to left parieto-occipital craniotomy without evidence of nodular enhancement to suggest tumor recurrence in this location. There is unchanged confluent white matter T2 hyperintensity in the treatment bed region. There is an unchanged subcentimeter enhancing lesion within the fundus of the right internal auditory canal. There is an unchanged developmental venous anomaly in the brainstem associated with punctate foci of susceptibility effect that likely represent cavernous malformations. There is unchanged mild encephalomalacia in the left cerebellar hemisphere. There is a punctate focus of high T2 signal in the anterior right precentral gyrus without discernible restricted diffusion. Otherwise, there is no evidence of acute infarct. The ventricles and basal cisterns are stable in size and configuration, with ex vacuo dilatation of the left lateral ventricle. There is an unchanged right cerebral convexity subdural fluid collection, but the left cerebral convexity subdural fluid collection has decreased in size. There is minimal midline shift to the left. The skull and extracranial soft tissues are unchanged.
1. Increase in size of left inferior temporal lobe and left middle frontal lobe metastasis. Otherwise, no significant interval change in size and number of the intracranial metastatic disease.2. An unchanged subcentimeter right internal auditory canal lesion may represent a vestibular schwannoma versus less likely a metastasis.3. Unchanged developmental venous anomaly in the brainstem associated with punctate foci of susceptibility effect that likely represent cavernous malformations.4. Unchanged right cerebral convexity subdural fluid collection, but decreased left cerebral convexity subdural fluid collection.