Secondary malignant neoplasm of brain [C79.31], Reason for Study: ^Reason: Patient with history of metastatic NSCLC with known brain mets now with wobbly gait. Please eval for worsening mets or leptomeningeal disease History: Wobbly gait Diffuse non nodular leptomeningeal enhancement is seen on today' scan which is non specific but may indicate leptomeningeal inflammation or metastatic involvement. Previously seen multiple enhancing metastatic nodules were redemonstrated with some lesions such as left inferior parietal lobule, right frontal deep white matter and right occipital lobe show interval increase in size and enhancement degree. The left parietal lobe, mainly superior parietal lobule but involving inferior parietal lobule acute/subacute ischemic stroke lesion shows increased extent of restricted diffusion areas and shows intra lesional susceptibility artifacts on gradient echo images indicating hemorrhagic transformation. The ventricles, sulci and cisterns are symmetric and unremarkable. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.
1. Interval increase of the extent of acute/subacute ischemic infarction on the left parietal lobe with evidence of hemorrhagic transformation.2. Interval increase in size and the degree of enhancement on some metastatic brain parenchymal lesions since prior scan.3. Diffuse non nodular enhancement of leptomeninges indicating possible leptomeningeal inflammation or metastasis.