Stage IV non-small cell lung cancer now with headaches for two weeks. There is no evidence of intracranial hemorrhage or acute infarct. However, there is a new 5 mm focus of high T2 signal in the superior right cerebellar hemisphere, which demonstrates no appreciable enhancement. There are additional unchanged scattered punctate foci of increased T2 signal in the periventricular white matter, which are nonspecific, but suggest chronic small vessel ischemic disease. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.
A new punctate focus of T2 signal in the right cerebellum is nonspecific, but could represent an unusual metastasis, among other differential considerations. 