83 years, Male, lung cancer, memory problems. There is a 1.5 x 1.5 x 1.4 cm (AP x transverse by craniocaudal dimensions) lesion centered on the hypothalamus with local mass effect on the anterior inferior aspect of the third ventricle and partial effacement of the superior aspect of the interpeduncular cistern. Mamillary bodies may be compressed or infiltrated with the lesion. Lesion also abuts the optic tracts.Remainder of the brain demonstrates no additional mass or evidence of mass effect, midline shift, or herniation. There is no hydrocephalus. There is mild to moderate degree of global parenchymal volume loss, commensurate with patient's advanced age. There are scattered foci of T2/FLAIR hyperintensity in the periventricular and subcortical white matter which are nonspecific but compatible with mild chronic small vessel ischemic disease.Small right maxillary sinus mucus retention cysts. Bilateral lens implants. Bone marrow signal and remainder of the extra cranial soft tissues are grossly unremarkable.
Evaluate of metastatic disease is limited without intravenous contrast, which patient refused. There is a 1.5 x 1.5 x 1.4 cm lesion centered on the hypothalamus with local mass effect. Differential is broad in the absence of contrast and includes benign and malignant etiologies including metastasis. Comparison with prior studies would be helpful if postcontrast imaging is not performed. No additional masses elsewhere in the brain are present.