Clinical question: Assess metastases. Signs and symptoms: Headache, nausea, new brain metastases. Pre and post enhanced brain MRI:There is a mildly hemorrhagic enhancing metastatic lesion along the superior-anterior left cerebellum measuring approximately at 18 x 19 mm in transaxial dimensions, demonstrate surrounding vasogenic edema and resultant mass effect.There is a smaller minimally hemorrhagic and enhancing tumor in the vermis measuring approximately at 14 x 19 mm in transaxial dimensions, mild surrounding basal genic edema and mass effect. There is a larger nonhemorrhagic and poorly enhancing additional metastatic lesion in the right posterior-inferior cerebellar measuring approximately at 26 x 23 mm in transaxial dimensions, extensive surrounding vasogenic edema and mass effect. Constellation of findings results in increased mass effect in the posterior fossa, decreased fourth ventricle, mild crowding of the foramen magnum however without mass effect on the corticomedullary plate cistern.Images through the supratentorial space demonstrate normal anatomical morphology of the brain with normal signal intensity on all MRI sequences. There is no detectable abnormal parenchymal or leptomeningeal enhancement to suggest metastatic lesion.Ventricular system remain within normal size and it maintained midline.Unremarkable images through the orbits and including axial fat sat post enhanced series.Calvarium demonstrates normal signal intensity and without abnormal enhancement.All paranasal sinuses and bilateral mastoid air cells and middle ear cavities demonstrate normal pneumatization signal patterns.
1.Multiple metastatic lesions in the posterior fossa with mild hemorrhagic changes and enhancement with resultant mass effect causing crowding of the foramen magnum however with no mass effect at the level of quadrigeminal plate cistern.2.Unremarkable pre and post enhanced brain MRI otherwise.3.Unremarkable calvarium, orbits, paranasal sinuses and mastoid air cells.