Diagnosis: Altered mental status. Altered mental statusClinical question: R/O brain metastasisSigns and Symptoms: delirium, new weakness The CSF spaces are appropriate for the patient's stated age with no midline shift. There is thickening of the left tentorial leaf along its medial aspectNo abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.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 are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.
There is mild and subtle nonspecific thickening of the left tentorial leaf along its medial aspect. Differential considerations may include the idiopathic thickening of the tentorial leaf though it could also be related to granulomatous or lymphomatous disorder. Metastasis would be unusual but can occasionally present as a dural based lesion as well. Please correlate with patient's clinical history. If clinically appropriate, a follow-up exam would be helpful.