Clinical question: Metastatic cancer of the parotid gland; follow-up from abnormal head CT. Signs and symptoms: As above. Pre- and post enhanced brain MRI:Examination demonstrate a ring-enhancing metastatic lesion in the left cerebellum measuring 11 x 8 x 12 mm in size. It demonstrates mild surrounding vasogenic edema without significant mass effect. A separate punctate focus of enhancement immediately to the left lateral aspect of this metastatic lesion is also noted and concerning for additional tiny metastases.There are bilateral posterior parietal necrotic ring-enhancing enhancing metastatic lesions measuring at 17 x 16 x 17 mm on the right and 16 x 10 x 8 mm on the left. Both lesions demonstrate surrounding vasogenic edema and the resultant regional mass effect/effacement of cortical sulci. A second left posterior parietal enhancing metastases measures at 4 mm on sagittal post enhanced series 13 image 21.Diffusion-weighted images also demonstrate a punctate/linear focus of restricted diffusion in the left cerebellum and a punctate focus of cortical restricted diffusion in the right high convexity posterior frontal lobe consistent with small acute nonhemorrhagic ischemic strokes.Slight prominence of cortical sulci for patient's stated age of 68 is noted. Ventricular system is slightly prominent however likely within normal range for age and with maintained midline. The signal void of major intracranial arterial branches are identified.The signal intensity of intracranial venous sinuses is within normal and without detectable abnormal enhancement.Unremarkable images through the orbits and including axial fat sat post enhanced series.Unremarkable calvarium, soft tissues of the scalp, paranasal sinuses and mastoid air cells.
1.Small foci of restricted diffusion in the left cerebellum and high convexity right posterior frontal consistent with small acute ischemic strokes.2.Multiple supratentorial and infratentorial necrotic/rim-enhancing metastatic lesions as detailed/measured above.3.Regional mass effect by metastatic lesions and surrounding edema however without mass effect on the ventricular system or deviation of midline.4.Unremarkable calvarium, orbits, paranasal sinuses and mastoid air cells.