Secondary malignant neoplasm of brain and spinal cord(198.3)Malignant neoplasm of bronchus and lung, unspecified site. Evaluate for response to WBRT The CSF spaces are appropriate for the patient's stated age with no midline shift. There is redemonstration of multiple ring-enhancing lesions within the brain parenchyma including right and left temporal lobes, right external capsule, left frontal lobe and right cerebellar hemisphere. The largest lesion is centered in the left temporal lobe which has increased in size from 22 x 27 mm axial dimensions to 42 x 39 mm axial dimensions. The one in the right external capsule has increased from 10 x 8 mm to 14 x 10 mm axial dimensions. One adjacent to the right temporal horn of the right lateral ventricle previously measured 15 x 10 mm and now measures 14 x 9 mm axial dimensions. A left superior frontal gyrus lesion previously measured 7 x 10 mm axial dimensions and now measures the same. A left precentral gyrus lesion has a decreased in size. Previously measured 10 x 8 mm axial dimensions and now measures 4 x 3 mm axial dimensions a right cerebellar lesion has also decreased in size. It previously measured 10 x 11 mm and now measures 7 x 5 mm axial dimensions. A left cutaneous lesion has increased in size from 11 x 8 mm to 12 x 9 mm. There is associated midline shift present which was also present on the prior exam. The internal cerebral veins are shifted approximately 7 mm to the right of midline on the current exam and were shifted by approximately this same on the prior exam. There is associated uncal herniation which was also present on the prior exam.The extent of T2 signal change compatible with vasogenic edema as well as periventricular white matter signal change has mildly progressed compared to the prior exam. Brainstem signal changes remain stableOn susceptibility weighted imaging there are are some punctate foci of signal loss in the left insular cortex and left frontal lobe which were not present on the prior exam.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.
1.Since the prior exam some the patient's lesions have decreased in size while others have increased in size as detailed above.2.There is mass effect with subfalcine and mild uncal herniation. This remains stable.3.Extensive white matter signal changes in the brain parenchyma has increased when compared to the prior exam. In part some this may be related to vasogenic edema and in part some this may be related to posttreatment change. 4.There is a microhemorrhage is present on the current exam which are now present on the prior located in the left hemisphere surrounding the left temporal lobe lesion. It is possible that these are treatment related.