Clinical question: 74-year-old male with head and neck cancer, cerebellar metastases. Evaluate new metastases. Signs and symptoms: Seizure, dizziness, dysautonomia, orthostatic hypotension. Pre-and post enhancement MRI:Negative diffusion weighted images.Examination demonstrates a stable small hemorrhagic metastatic lesion in the left cerebellum without associated surrounding edema or significant mass effect or interval change. The lesion similar to prior exam measures approximately 7 mm. There is no evidence of any new foci of parenchymal signal abnormality or enhancement to suggest new metastatic lesions. Few punctate size foci of flair hyperintensity in the subcortical and periventricular white matter are nonspecific however could represent mild chronic small vessel ischemic strokes in proper clinical setting. This finding also remains identical to prior study.Unremarkable cerebral cortex, cortical sulci, ventricular system and the CSF spaces and with maintained midline.Calvarium and orbits are unremarkable and without abnormal enhancement.
1.No evidence of an acute or new findings since prior exam.2.Stable approximately 7 mm hemorrhagic metastatic lesion in the left cerebellum without mass effect or surrounding edema.3.No detectable new metastatic lesions.4.Negative diffusion weighted series and the findings suggestive of mild chronic small vessel ischemic strokes.