Clinical question: Evaluate for altered mental status in patient with metastatic lung adenocarcinoma. Signs and symptoms: 76-year-old male with newly diagnosed stage IV lung cancer. Enhanced head CT:60 cc of Omnipaque 350 is administered for this study.There is a focus of subtle increased density in the inferior aspect of the vermis measuring approximately 14 times 10-mm in size (axial image 7). There is no distinct mass effect or any detectable surrounding vasogenic edema. Possibility of artifact cannot be entirely ruled out considering patient's history. Recommend further follow-up with enhanced brain MRI. The fourth ventricle is normal in size. Images through the supratentorial space demonstrate no findings to suggest metastatic lesion. There are however subtle subcortical and periventricular low-attenuation of white matter in bilateral cerebral hemisphere concerning for moderate degree of small vessel ischemic stroke of indeterminate age. The cortical sulci, ventricular system and all CSF cisterns remain within normal.Limited images through the orbits are unremarkable.Calvarium is intact.
1.One subtle focus of increased density/enhancement in inferior aspect of vermis with no associated surrounding vasogenic edema or any detectable mass effect. To exclude possibility of metastatic lesion recommend follow-up with an MRI exam.2.Small vessel ischemic strokes of indeterminate age.3.Calvarium is intact.