Diagnosis: Unspecified psychosis Malignant neoplasm of breast (female), unspecified siteClinical question: R/O brain metastasisSigns and Symptoms: confusion, h/o metastatic breast cancer There are multiple enhancing lesions scattered in both hemispheres of the brain as well as the left cerebellar hemisphere which are associated with vasogenic edema. The largest one is located in the left frontal lobe and measures 30 1I 28 mm axial dimensions and is centered in the left middle frontal gyrus. One in the right middle frontal gyrus measures 10 x 13 mm axial dimensions. One in the left cuneus measures 12 mm. One in the left inferior parietal lobule measures 12 mm smaller lesions are located in the left temporal lobe and left and right frontal lobes as well as the right occipital lobe. A couple lesions are present in the left cerebellar hemisphere the largest one measuring 10 mm diameter.There is associated mass effect and midline shift. The septum pellucidum is shifted approximately 6 mm to the right of midline. The uncus is deviated medially.A small lesion in the right side of the corpus callosum measuring 6 mm diameter is associated susceptibility effect.Normal 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 visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.
Multiple lesions within the brain parenchyma are compatible with metastatic disease to the brain. One of the lesions in the corpus callosum is hemorrhagic. The largest one is located in the left frontal lobe and there is associated midline shift and subtle uncal deviation/herniation medially. There is a moderate amount of vasogenic edema associated with these lesions.