Diagnosis: Secondary malignant neoplasm of brainClinical question: 74 yo M with metastatic SCC to brain s/p SRS to L cerebellum, eval for new lesions 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 laterally and one in the left cerebellar hemisphere 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 there is no associated contrast enhancement. 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 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 July 2015 exam.2.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related. 