Unspecified convulsions [R56.9], Reason for Study: ^Reason: brain metastasis History: new onset seizures Brain MRIMultifocal various sized susceptibility artifacts on bilateral hemisphere which could represent chronic petechial hemorrhages or mineralization.Scattered T2/FLAIR high signal intensity lesions on bilateral periventricular white matter indicate nonspecific small vessel ischemic disease.There is no evidence of acute ischemic or hemorrhagic lesion.There is subtle T2/FLAIR high signal intensity seen within the proximal right post central sulcus (series 701, image 25). However, this lesion does not show any evidence of enhancement on post Gad images, nor shows any evidence of susceptibility artifacts. Thus, this is non specific. It could represent slow flow cortical vein or an artifact. However, local proteinaceous materials including small amount of subarachnoid blood products cannot be completely excluded.The ventricles, sulci and cisterns are unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. The paranasal sinuses are clear.Bilateral (right worse than left) mastoid air cells show opacifications.Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate normal ICAs, MCAs and ACAs. Vertebrobasilar system appears to be normal.Neck MRA3D MRA neck post-gadolinium images with maximum intensity projections of the cervical vasculature demonstrate normal flow enhancement in a normal aortic arch origin of the right brachiocephalic, left common carotid, and left subclavian arteries. The vertebral artery origins are normal. There is normal flow enhancement through the bilateral common carotid, carotid bifurcations, internal/external carotid, and vertebral arteries.
1. No evidence of acute ischemic or hemorrhagic lesion. No abnormal enhancement.2. Non specific increased signal intensity on the proximal right post central sulcus on T2/FLAIR image.3. Multifocal bihemispheric chronic petechial hemorrhages or mineralizations.4. Non specific small vessel ischemic disease. 5. Normal brain MRA and Neck MRA. 