Sepsis, unspecified organism [A41.9] / Other fatigue [R53.83] / Dysphagia, unspecified [R13.10], Reason for Study: ^Reason: rule out brain metastasis; weakness, tinnitus, and possible confusion and falls at home History: h/o lung mass and liver nodules There are multifocal restricted diffusion lesions involving right superior frontal gyrus, right middle frontal gyrus, left parietal lobe periventricular white matter, left occipital lobe, left cerebellar hemisphere and 2 suspicious lesions on the right cerebellar hemisphere indicating acute ischemic stroke. These lesions do not show susceptibility artifacts suggesting they are not associated with intra-lesional hemorrhages.On Gad enhanced images, there is no evidence of diffuse meningeal enhancement.However, there is focal enhancing nodular lesion on the left lateral ventricle periventricular white matter (series 1301, image 107). This could represent metastatic nodule.Underlying brain shows scattered FLAIR high signal intensity lesions on bilateral periventricular white matter indicating non specific small vessel ischemic disease.The ventricles, sulci and cisterns are symmetric and unremarkable. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.
1. Multifocal restricted diffusion lesions on bilateral hemispheres and cerebellum indicating multifocal supra and infra tentorial ischemic strokes without evidence of hemorrhagic conversion.2. There is no evidence of diffuse meningeal enhancement.3. A small enhancing nodule on the periventricular white matter adjacent to the left lateral ventricle which possibly indicate single metastatic nodule.4. Underlying non specific small vessel ischemic disease.