79 years Female (DOB:9/11/1936)Reason: 79 yo female with newly diagnosed possible metastatic lung CA with reports of confusion, evaluate for brain metastases History: confusionPROVIDER/ATTENDING NAME: SHANNON K MARTIN SHANNON K MARTIN There is a moderate degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. These have progressed since the prior exam. There is redemonstration of additional T2 hyperintense foci in the brainstem, thalami and basal ganglia which were present to a lesser degree on the prior exam.A focus of susceptibility effect is present in the right centrum semiovale.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 demonstrate mucosal thickening in the right ethmoid air cells. 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. Probably related to remote hemorrhage this has progressed since 2003.2.Multiple old lacunar infarcts in the basal ganglia, thalami and brainstem have increased in number relative to the prior exam from 2003.3.Hemorrhagic focus right centrum semiovale.4.No evidence for brain metastases.5.Examination is mildly degraded by patient motion which may obscure more subtle abnormalities.