Diagnosis: Secondary malignant neoplasm of brain and spinal cord Secondary and unspecified malignant neoplasm of lymph nodes, site unspecified Squamous cell carcinoma of skin, site unspecified Secondary malignant neoplasm of brain and spinal cord Secondary and unspecified malignant neoplasm of lymph nodes, site unspecified Squamous cell carcinoma of skin, site unspecifiedClinical question: Hx of metastatic HNSCCa with single L occipital metastasis s/p SRS, surveillance scanSigns and Symptoms: HA, poor balance The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.There is redemonstration of 2 foci of susceptibility effect in the left cerebellar hemisphere 1 laterally and one medially which are only seen on the susceptibility weighted images. The one located on the lateral aspect has been identified as an enhancing nodule on the 8/12/2014 exam and could also be seen on the recent 3/21/2015 exam. On the current exam it is a punctate focus some enhancement only not significantly different than on the prior exam. The one on the medial aspect of the left cerebellar hemisphere is not readily identified on the postcontrast images on the current exam nor on prior exams. It can be identified as far back as 10/22/2014 on susceptibility weighted images.A couple punctate foci of susceptibility weighted image signal loss in the periventricular white matter were also present on the prior exam. In isolation these are of uncertain significance.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 some minor mucosal thickening in the right maxillary sinus. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. The eyeball lenses are thin.
1.Findings suggest hemorrhagic lesions in the left cerebellar hemisphere which have been identified on prior exams and are stable since the March 2015 exam. The more lateral one of the two was larger on prior exams and has decreased in size over time and likely represented metastasis. The more medial lesion is only identified on susceptibility imaging. The possibility that this represents another metastatic focus cannot be excluded.2.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related. 