Clinical question: 45-year-old male with metastatic lung cancer. No known brain metastases. Right facial droop and seventh nerve palsy. Signs and symptoms : Right facial droop. Pre and post enhanced brain MRI:Examination degraded in particular on post enhanced images due to motion artifact.Diffusion-weighted series demonstrate punctate multiple foci of restricted diffusion in bilateral (R>L) inferior cerebellar, left superior cerebellum, right posterior temporal cortex, left basal ganglia/caudate nucleus, right thalamus, right anterior frontal subcortical and cortical and left high convexity anterior frontal and multiple smaller scattered cortical foci in bilateral frontal cortices. Findings are consistent with diffuse small embolic metastatic lesions. None of the lesions demonstrate associated hemorrhagic changes or enhancement.Many of the above detailed ischemic strokes are identified on flair and T2 weighted images. On post enhanced series however there is a single focus of and enhancement measuring approximately 5.8 mm in the left occipital lobe (axial post enhanced series 13 image 15) and highly concerning for a metastatic lesion. There is no associated flair or T2 signal abnormality and no detectable hemorrhagic changes.Calvarium demonstrate no abnormal signal or enhancement.Unremarkable images through the orbits and including axial fat sat post enhanced series.Paranasal sinuses demonstrate minimal chronic sinus disease the maxillary sinuses.Extensive opacification of right mastoid air cells is noted.
1.Scattered punctate foci of restricted diffusion in bilateral cerebral and cerebellar hemispheres as detailed. No hemorrhage or enhancement this findings.2.Single ring enhancing lesion measuring 5.8-mm in the left occipital lobe without surrounding edema or hemorrhagic changes and highly concerning for metastatic lesion.3.Unremarkable calvarium and orbits.