Clinical question: Cause of acute confusion? 47-year-old male with malignancy status post chemotherapy/RT. Signs and symptoms: Patient found steering into space; unintelligible speech. Pre and post enhanced brain MRI:Examination demonstrate a necrotic ring-enhancing metastatic lesion in high convexity left posterior frontal lobe measuring 8 x 10 mm in transaxial dimensions. No surrounding edema or appreciable mass effect. Additional smaller necrotic rim-enhancing metastatic lesion in the left posterior parietal measuring 7 x 9 mm in transaxial dimensions without surrounding edema or mass effect.2 punctate foci of subcortical enhancement in the right posterior frontal lobe without edema or mass effect also consistent with metastatic lesions are present. There is no significant edema or mass effect and the ventricular system remains within normal size without deviation of the midline.Unremarkable intracranial contents otherwise.Unremarkable images through the orbits and calvarium and including axial fat sat post enhanced series.Well-pneumatized paranasal sinuses and bilateral mastoid air cells however with evidence of a right maxillary retention cyst.
1.Multiple small enhancing metastatic lesions in supratentorial brain parenchyma without appreciable surrounding edema or mass effect.2.Unremarkable pre and post enhanced brain MRI otherwise.