Clinical question: Brain metastases? Breast-cancer. Signs and symptoms: Confusion. Post-enhanced brain MRIunremarkable diffusion weighted series.Examination demonstrates mild periventricular and subcortical findings of chronic small vessel ischemic strokes. Extensive similar findings are also detected in pons without evidence of similar lesions in the basal ganglia or thalami. Unremarkable cerebral cortex, cortical sulci, ventricular system and CSF spaces otherwise for patient's stated age of 66.The signal void of major intracranial arterial branches are identified.Images through the orbits, paranasal sinuses, mastoid air cells, calvarium and soft tissues of the scalp are unremarkable.There is no detectable abnormal parenchymal, leptomeningeal, calvarial or orbital enhancement to suggest metastatic disease.
1.No evidence of metastatic disease.2.Negative diffusion weighted images and findings of chronic non-hemorrhagic small vessel ischemic strokes as detailed above.