Reason: History of esophageal ca, now with hyponatremia. rule out metastatic disease History: Hyponatremia, nausea, vomiting The CSF spaces are appropriate for the patient's stated age with no midline shift. There is leptomeningeal enhancement present along the cerebellar hemispheres bilaterally associated with flair signal hyperintensity along the cerebellar folia bilaterally. There is also some leptomeningeal enhancement present along the surface of the brainstem especially at the quadrigeminal plate.Punctate foci of flair signal hyperintensity are present in the right basal ganglia .No 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.There are a couple of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.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.Leptomeningeal involvement of the posterior fossa structures is present which could be a result of leptomeningeal carcinomatosis though meningitis may have a similar appearance.2.A punctate lesion in the right basal ganglion could be a result of a prior lacunar infarct .3.A couple subcortical white matter lesions are likely of little clinical significance.4.An alphanumeric page and an email with the results were sent to Emeka Anyanwu on the date of the exam.