Diagnosis: Encounter for examination for normal comparison and control in clinical research programClinical question: metastatic melanoma to brain, eval for disease, baseline for txSigns and Symptoms: as above There is redemonstration of multiple enhancing foci associated with susceptibility effect scattered in both hemispheres of the brain. One located in the right caudate nucleus currently measures 8 x 7 mm improved slightly measured 10 x 9 mm axial dimensions on the October exam, however, it measured 8 x 9 mm on the August 7 exam. One in the left inferior parietal lobule measuring 3 mm on the August 7 exam currently measures 6 x 6 mm and on the 10/2 exam measured 5 x 6 mm to the extent of visualization. Many of the hemorrhagic foci on the susceptibility images are not seen on the postcontrast images.There is redemonstration of diffuse periventricular and subcortical white matter confluent signal changes which were also present on the previous exams to a similar extent.The patient is status post right-sided craniotomyNormal 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 demonstrate minor opacities. The visualized portions of the orbits are intact.
1.There are multiple lesions scattered throughout the supratentorial brain which although larger than the August exam appear relatively stable and compared to the October exam and perhaps a couple of them are smaller. Please note however, that slice thickness on the current exam was 2 mm whereas slice thickness on the prior exam from Highland Park was 5 mm on the postcontrast images as a result minor discrepancies in size could be related to differences in sampling in addition to differences in technique.2.Extensive and diffuse white matter signal changes have been present on prior exams and are most likely treatment related.