Diagnosis: Late effects of accidental fallClinical question: eval for malignancySigns and Symptoms: pathologic fractures, weaknessComments: Already had brain without. Needs with only contrast enhance imaging.| MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a small enhancing lesion in the left middle cerebellar peduncle with surrounding T1 hypointensity.There is a large perivascular space in the left basal ganglia possibly related to microhemorrhages when correlation with recent SWI imaging.There is a small right sided subdural effusion present adjacent to the right parietal lobe which is stable since prior exams.Lumbar spine:There is an anterior compression fracture present at L1 associated with mild enhancement. The posterior aspect of the vertebral body is concave in shape. There is a milder superior en-plate compression fracture at T12.Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment. The conus medullaris on sagittal imaging is grossly intact. No abnormal enhancing lesions are identified in the lumbar spine.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is a small right paramedian disk protrusion at this level associated with contrast enhancement but no significant compromise to the adjacent nerve roots.At L4-5 there is no significant compromise to spinal canal or neural foramina.At L3-4 there is no significant compromise to spinal canal or neural foramina. There are endplate reactive changes present anteriorly at this level.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.There are multiple small renal cysts present.
1.Left middle cerebellar peduncle lesion demonstrates some associated breakdown of blood brain barrier. This could suggest that this is inflammatory in nature or reaction to a prior a late subacute/early chronic infarction. It is conceivable that this could relate to neoplasm. If the patient has a known primary tumor elsewhere, this could represent metastasis. A follow-up exam in 6-12 weeks would be useful. Please correlate with clinical symptoms.2.There is a benign appearing compression fracture at L1 in the subacute phase.3.There is a mild superior endplate compression fracture at T12 in a more chronic phase.4.Findings suggest a left adrenal gland lesion. Please refer to abdominal CT for further comments.5.Small right subdural effusion.6.Small L5-S1 disk protrusion with signs of acute/subacute stage.