40 years Male (DOB:11/21/1975)Reason: eval hemorrhagic mets, hydro, preop shunt History: headachePROVIDER/ATTENDING NAME: JEFFREY D. JACOBS JEFFREY D. JACOBS The patient status post left frontal craniotomy for left frontal lobe lesion.Since the prior examination the patient is developed new hemorrhagic lesions within the brain parenchyma and previous hemorrhagic lesions within the brain parenchyma have enlarged. There is a new hemorrhagic focus in the right frontal lobe which on T2 imaging measures approximately 7 mm in diameter. Another one in the right medial frontal lobe is approximately 3 mm in size. It was not previously present. A lesion located in the right thalamus was not clearly present on the prior exam and measures 34 x 14 mm axial dimensions. It protrudes into the right lateral ventricle. The lesion is present in the left cerebellar hemisphere which measures approximately 1 mm in size. Another lesion adjacent to the occipital horn of the right lateral ventricle was present on the prior exam and demonstrates a fluid fluid level. It measures 11 x 8 mm axial dimensions. Another one in the right occipital lobe in the cuneus measures 2 mm. Another one in the right occipital L adjacent to the temporal lobe measures 7 mm and was not clearly demonstrated on the prior exam. One in the right temporal lobe medially measures 13 mm on the current exam and previously was not readily visualized. One in the left temporal lobe could only be seen on susceptibility weighted imaging on the prior exam and now can be seen on rest of the pulse sequences and measures 7 x 4 mm. The enhancement pattern with these lesions is predominantly heterogeneous.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.
1.Since the previous examination, the patient has developed multiple new hemorrhagic lesions while previously noted hemorrhagic lesions have enlarged. This is compatible with metastatic disease throughout the brain.