Altered mental status. History of metastatic renal cell carcinoma. Assess for brain metastasis. The study is at least moderately limited by patient motion, which is most pronounced on the postcontrast images. There is no gross contrast enhancing or space-occupying brain lesion. Numerous, patchy T2 FLAIR hyperintense foci in the cerebral white-matter and, to lesser extent, the brainstem and cerebellar white-matter are nonspecific. A focus of susceptibility effect involving the superficial right cerebellar hemisphere is associated with focal encephalomalacia and probably represents a chronic infarct with hemosiderin staining. A tiny focus of cortical T2 FLAIR hyperintensity in the right occipital lobe medially without associated diffusion restriction is probably a tiny chronic infarct. There is suggestion of an incidental right cerebellar developmental venous anomaly on susceptibility weighted imaging. The ventricles and other CSF-containing spaces are mildly expanded reflecting underlying brain volume loss. There is no midline shift or brain herniation. Major intracranial vascular flow voids are grossly preserved, reflecting gross patency.There is no gross orbital abnormality or destructive skull lesion. The mastoid air cells are clear.
1.At least moderately limited examination, by patient motion.2.There is no gross contrast enhancing or space occupying brain lesion to suggest brain metastasis.3.There is no gross diffusion restriction to indicate acute infarct.4.Moderate burden of nonspecific brain white-matter lesions is most likely from chronic microvascular ischemia. Focal encephalomalacia and punctate hemosiderin staining in the right cerebellar hemisphere probably reflect chronic infarct.