Known breast cancer patient metastasis to brain, seizure, new facial droop. No evidence of acute ischemic or hemorrhagic lesion on the scan.Patch bilateral periventricular white matter high signal intensity on FLAIR imaging indicate likely nonspecific small vessel ischemic disease.There are matching high signal intensities on FLAIR imaging and T2-weighted imaging corresponds to previously noted enhancing metastatic lesions, however, further MR characterization cannot be performed due to lack of contrast enhancement scans.No change of left parietal skull lesion, likely represents hemangioma.The ventricles, sulci and cisterns are symmetric and unremarkable. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses are clear. Bilateral mastoid air cells show fluid collection.3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate normal ICAs, MCAs and ACAs. Vertebrobasilar system appears to be normal. Left P-comm artery is patent, right ACA A1 segment is hypoplastic.3D MRA neck post-gadolinium images with maximum intensity projections of the cervical vasculature demonstrate normal flow enhancement in a normal aortic arch origin of the right brachiocephalic, left common carotid, and left subclavian arteries. The vertebral artery origins are normal. There is normal flow enhancement through the bilateral common carotid, carotid bifurcations, internal/external carotid, and vertebral arteries.
1. No evidence of acute ischemic or hemorrhagic lesion on the scan.2. Nonspecific small vessel ischemic disease, scattered multiple high signal intensity foci corresponding to previously noted metastatic lesions on FLAIR and T2-weighted images are again seen, and no significant interval change. However, further MR characterization cannot be performed due to lack of contrast enhanced the scan.3, normal brain MRA and neck MRA. 