Right leg and arm weakness. Brain MRI:There are multiple scattered restricted diffusion on the left frontal, parietal and occipital lobes, in particular cortical and subcortical location. In addition, the left caudate head as well as anterior aspect of basal ganglia also show restricted diffusion. These lesions represent acute ischemic infarct.There is no evidence of acute hemorrhagic lesion.There is evidence of chronic ischemic infarct on the left PCA territory, especially occipital lobe with encephalomalacia.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.Whole spine MRI (acute cord compression protocol) and thoracic MRI;There is no evidence of cord compression on the scan.Normal cervical lordosis, thoracic kyphosis as well as lumbar lordosis were seen.There is evidence of soft tissue mass involvement on the T11 and T12 including bilateral pedicels indicating metastatic lesions. Those lesions narrows bilateral (more on the right) neural foramen. Especially at the level of T11, the right side pedicle as well as neural foramen appears to be invaded by the mass lesion. The lesions show mainly peripheral enhancement and encasing the spinal canal at the level of T11 and T12, however, there is no evidence of spinal cord signal abnormality.Included thoracic cavity shows multiple enhancing lesions bilateral pleural spaces with pleural effusion again indicating metastatic lesion.
1. Acute ischemic infarctions on the left hemisphere including left caudate head and basal ganglia without evidence of hemorrhagic conversion.2. Multifocal soft tissue masses including T11 and T12 vertebral bodies and adjacent muscle indicating metastatic lesions.3. Multifocal bilateral pleural mass lesions with pleural effusions also suggest possible metastatic lesions. 4. T11 and T12 level spinal canal appears to be encased by soft tissue mass lesions, however, there is no evidence of abnormal spinal cord signal intensity indicating cord compression.