SCLCL, status post treatment with brain lesions, possibly paraneoplastic encephalopathy. There are multiple cerebral cortical foci of high T2 signal with corresponding hypermetabolism on PET, including within the right lateral orbitofrontal gyrus, bilateral inferior temporal gyri, and let occipital and parietal lobe, which have deceased in size since December 2015. There is no discernible corresponding abnormal enhancement, although the post-contrast images are degraded by motion. There are otherwise unchanged scattered areas of cerebral white matter T2 hyperintensity. The limbic system appears unremarkable. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The ventricles and basal cisterns are unchanged in size and configuration, with diffuse cerebral volume loss. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. There are bilateral enlarged parotid and suprahyoid lymph nodes, left larger than right.
1. Multiple cerebral cortical foci of high T2 signal with corresponding hypermetabolism on PET have deceased in size since December 2015. These lesions may represent a form of paraneoplastic encephalopathy rather than metastases.2. Bilateral enlarged upper neck lymph nodes are compatible metastatic disease.