Diagnosis: Syncope and collapseClinical question: eval for CNS mets with hx of Lung Ca and prior CNS metsSigns and Symptoms: hx of lung ca, prior CNS mets, syncope There is redemonstration of a confluent periventricular and subcortical white matter T2 and FLAIR signal hyperintense. Compared to the previous exam from November this does not appear to have progressed significantly.There is redemonstration of a punctate focus of signal loss on susceptibility weighted imaging which has not changed since the prior exam.No abnormal enhancing mass lesions are appreciated intracranially to suggest brain metastases. 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 mild mucosal thickening involving the right maxillary sinus and mucous retention cysts in the left maxillary sinus as well as mucosal thickening in ethmoid air cells..Incidental note is made of partial empty sella.. The visualized portions of the mastoid air cells are partially opacified. The visualized portions of the orbits are intact.
1.There is no evidence for brain metastases. 2.There is no evidence for acute cerebral ischemic infarction3.There is diffuse periventricular white matter signal change present which is most likely treatment related.