Diagnosis: Unspecified abnormalities of gait and mobility. Malignant neoplasm of unspecified part of unspecified bronchus or lung Secondary malignant neoplasm of brainClinical question: Pt w/ NSCLC brain mets, s/p SRS to R cerebellar met and subsequent WBRT. Now on PD1 Ab.Signs and Symptoms: gait difficulty. Falls. Brain mets. NSCLC. The CSF spaces are appropriate for the patient's stated age with no midline shift. There are no foci of diffusion restriction appreciated within the brain parenchyma.There is a 6 x 3 mm axial dimension focus of contrast enhancement in the medial aspect of the right cerebellar hemisphere. This associated with susceptibility effect on the susceptibility weighted images.There is a punctate focus of enhancement present along the left isthmus of the cingulate gyrus which was also present on the prior exam and is unchanged since then however it is smaller than on the 6/8/2015 exam.There are other punctate foci of signal hypointensity on susceptibility imaging in the subcortical white matter which are also stable.There are patchy T2 and FLAIR signal hyperintensities in the brainstem. These were not present on the January 2015 examPreviously noted small foci of enhancement in the paracentral lobules and left fusiform gyrus are not conspicuous on the current exam. These were not present on the January 2015 examThere is a mild degree of periventricular and subcortical patchy hyperintense white matter lesions present identified on the FLAIR and T2 images.No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate mucosal thickening in the maxillary sinuses and some scattered opacities in the ethmoid air cells. The visualized portions of the mastoid air cells demonstrate some scattered opacities in the right mastoid air cells. The visualized portions of the orbits are intact.
1.There is a small hemorrhagic focus present in the right cerebellar hemisphere. This remains stable over time.2.Multiple enhancing lesions present in the supratentorial brain are not conspicuous on the current exam suggests regression of metastatic load.3.A punctate lesion in the left cingulate gyrus isthmus is stable compared to the prior exams but smaller than the June exam.4.There are patchy periventricular and subcortical white matter T2 and FLAIR signal hyperintensities and brainstem T2 and FLAIR signal hyperintensities which were not present at the beginning of the year and are suspected to be posttreatment related.5.There is no evidence for acute cerebral ischemic infarction. 