52-year-old female with anisocoria, poor balance and incontinence. Evaluate for brain metastases. Further history reveals metastatic renal cell cancer history status post SRS to the right cerebellum. Since previous exam there has been interval increase in size of the hemorrhagic right basal ganglia metastatic lesion which now measures 1.2 x 1.2 cm (series 1001, image 19), compared to 0.4 x 0.6 cm previously. There is now a small amount of mass effect on the adjacent brain parenchyma as well as some surrounding parenchymal edema. There is small amount of mass effect on the adjacent sulci than right lateral ventricle. There is perhaps a small amount of focal leftward midline shift of 2 mm. Just posterior and medial to the right basal ganglia lesion is a second 3 x 5 mm enhancing focus which was not present on the prior examination and is suspicious for a additional site of metastasis.Within the right lateral cerebellum there has been interval decrease in the size and enhancement pattern of the hemorrhagic metastatic lesion. There is now only residual susceptibility abnormality and no appreciable enhancement status post SRS.The ventricles and basal cisterns are normal in size and configuration. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.
1.Interval increase in the hemorrhagic right basal ganglia metastatic lesion with mild surrounding edema and with some mild mass effect and sulcal effacement.2.Just medial and posterior to the right basal ganglia lesion is a small enhancing focus which is suspicious for a small new metastasis.3.Interval decrease in the size and enhancement of the right cerebellar metastatic lesion post-treatment, which now only demonstrates susceptibility abnormality.