Clinical question: Rule out brain metastases. Signs and symptoms:N/A Pre-and post-enhanced brain MRI:No diffusion weighted abnormalities.Flair and T2-weighted images demonstrate scattered foci of hyperintensity in the in the periventricular and subcortical white matter cerebral hemispheres and consistent with mild chronic nonhemorrhagic small vessel ischemic strokes. Unremarkable renal cortex, cortical sulci, ventricular system the CSF spaces for age.Post enhanced images are negative for any abnormal enhancement the brain parenchyma, leptomeninges, calvarial or the orbits to suggest metastatic disease. There however visualization of a small right occipital calcarine fissure developmental venous anomaly.Unremarkable orbits, paranasal sinuses, mastoid air cells and middle ear cavities
1.No evidence of metastatic disease.2.Negative diffusion weighted images.3.Mild chronic nonhemorrhagic small vessel ischemic strokes only in the subcortical and periventricular hemispheric white matter and normal signal intensity of brain parenchyma otherwise.4.A small right occipital calcarine fissure developmental venous anomaly is detected