Clinical question: rule out intracranial abnormality. CVA.signs and symptoms: History of cancer with brain metastases and after mental status Nonenhanced head CT:There is evidence of a right temporal craniotomy with focus of encephalomalacia under the craniotomy flap in the right anterior temporal lobe. There is no evidence of edema, hemorrhage or mass effect with this finding. The high convexity right frontal lobe there is a mass measuring approximately 11.9 x 8.4-mm on axial image 23. There is extensive surrounding vasogenic edema with resultant effacement of adjacent cortical sulci. This finding is believed to represent a metastatic focus.There are several small foci of low-attenuation in the subcortical white matter of left hemisphere which are not suggestive of metastatic disease and may represent small vessel disease ischemic stroke of indeterminate age. Follow-up with an MRI for detection of possible additional metastatic foci is recommended.There is no evidence of hemorrhage, midline shift or hydrocephalus.
1.Metastatic lesion in high convexity right frontal lobe with possible minimal hemorrhage measuring 8.4 x 11.9-mm in size.2.Ill-defined patchy areas of subcortical invagination suspected to small vessel ischemic stroke of indeterminate age.3.Evidence of a prior right-sided anterior temporal partial lobectomy as detailed above.