Diagnosis: Malignant neoplasm of upper lobe, left bronchus or lungClinical question: R arm tremor and shaking; concern for recurrent lung cancer The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a moderate degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.T2 and FLAIR hyperintense foci are present in the thalami and internal capsules bilaterally as well as in the brainstem.Punctate foci of susceptibility are present in the right thalamus and to a lesser degree left thalamusNo 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 are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.
1.Periventricular and subcortical white matter lesions of a moderate degree are nonspecific. At this age they are most likely vascular related. 2.Multiple lesions in the brainstem, internal capsule and thalami are most likely vascular related.3.Several microhemorrhages are present in the right thalamus and to lesser degree left thalamus4.There is no evidence for brain metastases appreciated.