Small cell lung cancer. Evaluate for brain metastasis. Confluent frontal and parietal periventricular in addition to patchy deep and subcortical white matter T2 hyperintense abnormalities without contrast enhancement or diffusion restriction probably reflect chronic microvascular ischemia. Similar changes are present in the pons. Focal CSF intensity lesion along the surface of the right cerebellar hemisphere probably representing a tiny chronic infarct. There is no diffusion restriction. There is no space-occupying or contrast-enhancing mass. There is no midline shift. The major intracranial vessels are patent.Orbits are normal. The paranasal sinuses and the mastoid air cells are clear other than very minimal right anterior ethmoidal mucosal thickening, most likely of no significance. There is no destructive skull lesion.
1.There is no contrast-enhancing or space-occupying brain lesion to indicate metastasis.2.Chronic microvascular ischemia as described above.