63 years Female (DOB:8/28/1952)Reason: evaluate for structural abnormality History: new onset headache in setting of cancer historyPROVIDER/ATTENDING NAME: SANDRA LYNN ROSE SANDRA LYNN ROSE The CSF spaces are appropriate for the patient's stated age with no midline shift. Periventricular and subcortical white matter lesions of a mild degree are nonspecific. At this age they are most likely vascular related. There is redemonstration of a couple T2 and FLAIR hyperintense focus along the left centrum semiovale. There is redemonstration of a couple T2 and FLAIR hyperintense lesions in the brainstem.Since the prior exam patient has accumulated new foci in the subcortical white matter of the left medial parietal lobe measuring 12 mm adjacent to the intraparietal sulcus and another one in the left middle frontal gyrus measuring 9 mm. These are associated with adjacent sulcal widening and focal volume loss. There is no associated contrast enhancement or any susceptibility effect.There is some vague enhancement along the frontal bones adjacent to the frontal sinuses adjacent to theNo abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.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 mucous retention cyst in the right maxillary sinus. Prior mucosal thickening in the frontal sinuses has cleared since prior exam. The visualized portions of the mastoid air cells demonstrate minor opacities. The visualized portions of the orbits are intact.Incidental note is made of hyperostosis frontalis interna.
1.Since the prior exam patient developed new small lesions in the left parietal lobe and left frontal lobe. There is suspected to be vascular related.2.There is redemonstration of a couple periventricular white matter lesions in the left centrum semiovale as well as a couple punctate lesions in the brainstem which are also likely vascular related. Please note that the predominance of lesions in the left hemisphere raise the question of possible left carotid disease. Please correlate with clinical findings.3.There is some and vague enhancement adjacent to the frontal sinuses bilaterally. This is nonspecific and could be inflammatory in nature. However, it is nonspecific and could represent something other than inflammatory reaction.4.No evidence for brain metastases.