41 years Female (DOB:10/7/1975)Reason: metastatic breast CA to brain, choroid of eye History: nonePROVIDER/ATTENDING NAME: PHILIP C HOFFMAN PHILIP C HOFFMAN The CSF spaces are appropriate for the patient's stated age with no midline shift. There are periventricular white matter lesions present which are rather confluent but not significantly changed since the July exam.There are multiple punctate foci of signal loss and susceptibility weighted imaging within the left frontal lobe subcortical white matter and periventricular white matter. Another subcortical punctate focus of susceptibility effect is present in the subcortical white matter of the right orbital gyrus and another couple are present in the right parietal lobe subcortical white matter and periventricular white matter. Another one is present in the right occipital subcortical white matter. A couple more are present in the cerebellum. Many of these were not present on the prior exam.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.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.No abnormal enhancing lesions are present in the brain parenchyma to suggest new metastatic disease.2.There are multiple microhemorrhages scattered throughout the brain many of which are new since the July exam. These are nonspecific. They could be posttreatment related. Sometimes hemorrhagic metastases can have a subtle appearance such as this.3.Periventricular white matter changes are redemonstrated which are likely treatment related.