Metastatic lung cancer to the brain status post radiation therapy a few years ago. Abrupt hearing loss. There are multiple supratentorial and infratentorial intracranial enhancing lesions. Since 2011, some new lesions have appeared, some have increased in size, and some have involuted. The largest lesions are associated with susceptibility effect and measure up to 15 mm in the left precuneus and 14 mm in the right posterior cingulate gyrus. Additional enhancing lesions are present in the cerebellar vermis, where there is extensive vasogenic edema. There is a background of diffuse T2 signal hyperintensity in the periventricular and subcortical white matter. There is no evidence of acute infarct. There is mild diffuse cerebral volume loss. There is no midline shift or herniation. There is scattered opacification of the bilateral mastoid air cells. The skull and extracranial soft tissues are otherwise unremarkable.
1. Numerous increase intracranial metastases, a few of which are associated with probable hemorrhage and vasogenic edema superimposed upon diffuse treatment effects in the brain parenchyma.2. No evidence of acute infarct.3. Fluid within the bilateral mastoid air cells is nonspecific, but may represent mastoiditis.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.