73-year-old female with history of breast cancer with brain metastases presenting with fulminant hepatic failure. Please evaluate for evidence of increased intracranial pressure. Focal encephalomalacia affecting the left temporal lobe is unchanged in appearance. Patchy low attenuation within the subcortical and periventricular white matter is nonspecific, and may be vascular in etiology. There is no intracranial hemorrhage or abnormal extra-axial fluid collections. There is no midline shift or mass effect. The ventricles are midline, with normal volume and morphology. The basilar cisterns are normal in appearance.Poorly defined lytic lesions affecting the right frontal and left frontal bones may represent metastases. There is also new lytic destruction of the right aspect of the clivus and petrous apex, concerning for metastasis. These were not present on the 4/25/2007 exam. Further evaluation with contrast-enhanced MRI may be considered to evaluate for leptomeningeal extension if clinically indicated. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.
1. No intracranial hemorrhage or evidence of increased intracranial pressure.2. New lytic lesions affecting the frontal bones and skull base are suspicious for metastases. Further evaluation with contrast-enhanced MRI may be considered if clinically indicated.