Diagnosis: Secondary malignant neoplasm of brainClinical question: colorectal ca with L cerebellar met s/p resection and post-op radiationSigns and Symptoms: eval for extent of disease The CSF spaces are appropriate for the patient's stated age with no midline shift. The patient is status post posterior fossa surgery for removal of a left cerebellar lesion. There is a loss of volume along the superior aspect of the cerebellar vermis associated with adjacent T2 signal hyperintensity and susceptibility effect. There is enhancement along the margins of the resection site. This enhancement was also present on prior exams, however, prior exams are somewhat degraded by patient motion. There is a 8 mm ring-enhancing focus along the superior aspect of the surgical resection site which has low signal centrally on T2 and associated with some adjacent signal change in the left superior cerebellar hemisphere.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.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 are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. There is thinning of the left posterior sclera compatible with staphyloma. The right eye is irregular in shape. There is no enhancing lesion identified in either eye. These findings are stable compared to prior exams.
1.Status post removal of a mass from the cerebellar vermis. A small nodule at the superior aspect of the resection site could potentially represent evolving postoperative change, however, it is somewhat nonspecific and could also represent some local recurrence. A follow-up exam could be helpful2.Stable appearance of the eyes with staphyloma in the left eye and ocular deformity on the right eye.3.Periventricular and subcortical white matter signal changes of a mild degree are present which are nonspecific. They could be vascular related, related to demyelination, trauma, vasculitis, sarcoid. They are nonspecific. 