Metastatic, Stage IV breast cancer, 1 week of N/V, dizziness, double vision. There are multiple supratentorial and infratentorial lesions with associated vasogenic edema. The largest of these is located in the posterior right temporal lobe and occipital lobe and measures approximately up to 3 cm, although assessment is limited by the lack of intravenous contrast. There is effacement of the right lateral ventricle trigone and a portion of the fourth ventricle, but no obstructive hydrocephalus. There are a few scattered foci of nonspecific cerebral white matter T2 hyperintensity. There is no evidence of acute infarct or gross hemorrhage, although some of the sequences are limited by patient motion. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, paranasal sinuses, and scalp soft tissues are grossly unremarkable. The right parietal skull lesion suggested by the bone scan is not discernible.
1. Multiple supratentorial and infratentorial lesions with associated vasogenic edema are compatible with metastatic disease, although assessment is limited by the lack of intravenous contrast.2. No midline shift or herniation. 3. The right parietal skull lesion suggested by the bone scan is not discernible, although assessment is limited by the lack of intravenous contrast.