Reason: Intracranial metastases and history of CVA with new neuro deficits, please evaluate History: As above. There are multifocal infratentorial and supratentorial areas of diffusion restriction involving the bilateral cerebellum, bilateral occipital lobes, bilateral medial frontal and parietal lobes as well as the head of the left caudate consistent with acute infarcts. These lesions are associated with increased T2 signal without susceptibility. A lesion in the left occipital lobe which exhibits gyriform diffusion restriction also demonstrates mild scattered enhancement, most likely representing infarction. There are 2 additional small curvilinear foci of enhancement within the right temporal lobe posterior to the right temporal horn which are associated with diffusion restriction. There is no definite enhancing lesions to suggest intracranial metastases. There are scattered additional areas of increased T2 signal without associated diffusion restriction which likely represent old infarcts. There is encephalomalacia in left cerebellum and right caudate.There is no evidence of intracranial hemorrhage. The ventricles and basal cisterns are normal 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.
1.Multiple intratentorial and supratentorial areas of diffusion restriction likely consistent with acute infarcts. Distribution suggests an embolic etiology.2.Curvilinear regions of enhancement in the left occipital lobe and right temporal lobe are associated with diffusion restriction and likely represent subacute infarcts, however underlying adjacent leptomeningeal metastatic deposits cannot be entirely excluded. Follow-up of these regions may be considered.