History of breast cancer with brain metastases treated via WBRT, now with altered mental status and seizures. There are several, approximately 10, supratentorial or infratentorial solid or ring enhancing lesions that are predominantly located at grey-white matter interfaces. The largest supratentorial lesion is located in the left thalamus and measures up to 9 mm. The largest infratentorial lesion is located in the superior vermis and measures up to 6 mm. Some of the lesions demonstrate surrounding vasogenic edema, particularly in the posterior fossa. A few of the lesions also demonstrate punctate susceptibility effect, which may represent blood products. There is diffuse bilateral patchy cerebral white matter T2 hyperintensity, which is likely treatment-related. There is no evidence of intracranial hemorrhage or acute infarct. The ventricles and basal cisterns are unchanged in size and configuration. 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. There is a subcentimeter T1 and T2 hyperintense lesion in the left parietal skull, which likely represents a hemangioma.
Multiple subcentimeter supratentorial and infratentorial lesions are compatible with metastases. 