66-year-old male with altered mental status and known metastatic melanoma to brain. Evaluate brain mets and edema. There is a punctate focus of restricted diffusion involving the right posterior medial parietal region with corresponding dark ADC suspicious for a punctate microinfarct.Redemonstrated are multiple lesions with FLAIR signal abnormality along the left anterior temporal lobe, left paramedian frontal lobe, right posterior temporal lobe are compatible with metastatic lesions. The lesion in the left anterior temporal lobe again demonstrates extensive surrounding vasogenic edema. There is small amount of vasogenic edema around the left paramedian frontal lobe lesion. Size comparisons are limited given the absence of contrast but these lesions appear similar in size and configuration. There is redemonstration of underlying mild periventricular and subcortical FLAIR signal abnormality which is nonspecific but is likely related to chronic small vessel ischemic disease. There is mild diffuse volume loss.There is no evidence of intracranial hemorrhage. The basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. There is fluid within the right mastoid air cell. The orbits, skull, paranasal sinuses, and scalp soft tissues are otherwise grossly unremarkable.
1.Findings suspicious for a punctate micro-infarct involving the posterior medial parietal region without mass effect or intracranial hemorrhage.2.Multiple areas of FLAIR signal abnormality corresponding to the enhancing lesions in the previous MRI exam within the left anterior temporal lobe, right posterior temporal lobe and left perimedian frontal lobe. Full comparison is limited in the absence of contrast, however the lesions appear grossly similar.3.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.4.The exam is somewhat limited due to the patient's inability to cooperate. SWI and T1 axial imaging were not performed.