Clinical question: Mass? Intracranial hemorrhage? Signs and symptoms: Central vertigo x 1 month history of metastatic melanoma to brain and with status post RT Non-enhanced head CT:A there is no evidence of intracranial hemorrhage, edema, mass-effect or midline shift or hydrocephalus.The cortical sulci, ventricular system, CSF cisterns are essentially minimal for patient's stated age of 74.Diffuse patchy areas of subcortical and periventricular low-attenuation are nonspecific however they are suspected for small vessel ischemic disease of indeterminate age. Similar findings were present on prior MRI examination from 12 -- 13 -- 2010.Calvarium is intact. Limited view of paranasal sinuses and mastoid air cells as well as middle ear cavities are unremarkable.Limited images through the orbit demonstrate ptosis bulbi of the right globe as was noted on multiple prior studies.
1.No evidence of any acute new findings in particular no evidence of hemorrhage or acute cortical stroke.2.Findings of small vessel ischemic disease of indeterminate age.3.Ptosis bulbi of right globe.4.Unremarkable calvarium, paranasal sinuses and mastoid air cells.