Metastatic esophageal cancer on therapy now, complains of slow speech, fatigue and increased sleepiness and decreased alertness. Please evaluate CNS status. There is no evidence of acute intracranial hemorrhage, mass, or acute infarct. There are scattered punctate foci of abnormal T2 hyperintensity within the periventricular and subcortical white matter, which are nonspecific. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The skull and extracranial soft tissues are unremarkable. There is mild mucosal thickening of the bilateral ethmoid and maxillary sinuses.
1. No evidence of intracranial metastatic disease. No acute infarct, intracranial mass or mass effect.2. Scattered foci of T2 hyperintensity within the periventricular and subcortical white matter, which are nonspecific, but likely represent chronic small vessel ischemic changes and/or treatment-related changes.