Non-small cell lung cancer with brain metastasis. Nausea and left more than right with weakness. Since the prior examination, there has been slight overall increase in the size of the multiple supratentorial and infratentorial contrast-enhancing brain metastatic lesions. For example, the largest lesion involving the right left cerebellum now measures 2.9 cm x 2.4 cm compared to 2.6 cm x 2.1 cm previously. The perilesional edema has also increased with increased involvement of the left brainstem and right cerebellar hemisphere. The associated compression of the fourth ventricle and midline shift in the posterior fossa are also increased as well as the downward herniation of the left cerebellar tonsil. The second largest lesion involves the posterior paracentral lobule and measures 2.8 cm x 2.6 cm, compared to 2.4 cm x 2.1 cm previously. There is a punctate focus of diffusion restriction adjacent to the metastatic lesion in the left frontal lobe. Otherwise, the diffuse background of T2-hyperintensity involving the cerebral white-matter has not significantly changed. Punctate foci of susceptibility effect remain unchanged. There are subcentimeter chronic lacunar infarcts in the bilateral thalami. Although the mass-effect on the fourth ventricle has increased, dilatation of the lateral and third ventricles remains unchanged. The skull and orbits appear to be unchanged.
1.Increase in the size of the multiple brain metastasis since the fairly recent examination of May 27, 2016. Progression of the largest lesion and the associated edema in the left cerebellar hemisphere result in increased compression of the fourth ventricle and left cerebellar tonsillar herniation. 2.Punctate focus of diffusion restriction in the left frontal lobe adjacent to the second largest metastatic lesion may represent a tiny recent infarct or may relate to the metastasis itself, such as a tumor embolus, or small vessel ischemic disease. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.