Newly diagnosed lung cancer, left side focal neurological deficit. Multifocal bihemispheric restricted diffusion lesions indicating acute ischemic infarctions involving right frontal lobe, left frontal lobe, left parietal lobe, caudate nucleus splenium, left occipital lobe, left temporal lobe and right cerebellar hemisphere.On Gradient echo images, there are focal signal voids on the right frontal lobe (junction of right superior frontal gyrus and pre central gyrus), left parietal lobe (inferior parietal lobule adjacent to the left parieto-occipital sulcus), and corpus callosum splenium. These lesions may indicate focal hemorrhagic transformation.On Gad enhanced images, there are multifocal nodular and ring enhancing lesions involving left frontal lobe middle frontal gyrus, left side of midbrain, right cerebellar hemisphere and possibly right posterior medullar (marked on series 1001) indicating possible metastatic nodules.In addition, gyriform enhancement of left temporo-occipital lobe cortex and left frontal lobe pre central gyrus hand motor center indicate subacute ischemic infarctions. The ventricles, sulci and cisterns are symmetric and unremarkable. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.
1. Multifocal acute and subacute ischemic infarctions with suspicious petechial hemorrhagic conversions as described above.2. Multifocal supra and infratentorial bihemispheric enhancing lesions indicating metastatic lesions as described above.