Breast cancer with brain metastasis. History of radiation treatment. Altered mental status. The predominantly left sided dural-based masses associated with overlying skull thicken and marrow replacement have progressed since the previous examination. For example, the dural component in the anterior aspect of the left middle cranial fossa, associated with the infiltrative lesion involving the left sphenoid triangle, now measures transaxially up to 19 mm and thickness, compared to 12 mm previously. Also, there has been progression in the other multifocal nodularity and masses overlying the left cerebral convexity and smaller soft tissue component in the scalp. There is new vasogenic edema-like T2-hyperintensity in the anterior aspect of the left temporal white-matter associated with mass-effect and mild midline shift and uncal herniation. Left cavernous sinus involvement is also increased. The ventricular system remains mildly dilated with mild periventricular T2-hyperintensity, likely reflective of volume loss. There is no intraparenchymal contrast-enhancing lesion. There is no acute infarct or acute intracranial hemorrhage. Fluid signal intensity now completely fills left mastoid air cells and middle ear cavity which might be congestive or inflammatory. Otherwise, there is trace mucosal thickening in the paranasal sinuses.
1.Since previous MRI of March 2016, there has been significant progression of the dural-based masses associated with skull metastasis. 2.The largest nodular component is in the anterior aspect of the left middle cranial fossa and is associated with new vasogenic edema in the left temporal lobe and mild mass-effect including mild midline shift and mild uncal herniation.3.There is also increasing left cavernous sinus involvement.