50 year-old male with chronic headache, cranial nerve dysfunction, known brain metastases, and intracranial hemorrhage presents with deteriorating mental status. There is interval increase in the size of the left thalamic hematoma to 2.7 x 2.2 x 3.2 cm (AP x TR x CC image 14; series 4) from 2.4 x 2.1 x 2.3 cm. This enlargement extends the hematoma further into the midbrain. There is probably also some increase in the amount of vasogenic edema in the surrounding area even allowing for technique differences: Edema and hematoma measure together 4.1 cm in diameter (15; series 4) compared to 3.5 cm on February 20. There is associated distortion and rightward displacement of the third ventricle which is stable. However, there has been slight interval enlargement of the lateral ventricles bilaterally. The temporal horn of the left lateral ventricle measures 9 mm, previously 6 mm. There is interval narrowing of the basal cisterns without evidence of frank brain herniation. There is no evidence of extra-axial fluid collection. Multiple mass lesions within the cerebral hemispheres are noted, some of them hyperdense consistent with petechial hemorrhage or mineralization. Findings are consistent with known metastatic lesions and appear grossly stable. The area of dominant left frontal lobe and right cerebellar hypoattenuation also appear grossly similar to the recent brain MRI. No new parenchymal lesions or hematomas are noted. However, MRI would be more sensitive if status of metastatic disease is of particular concern.The visualized mastoid air cells and paranasal sinuses are clear. The visualized orbits are unremarkable.
1. Interval enlargement of left thalamic hematoma with further extension into the midbrain. Additionally, there is probably an interval increase in the amount of vasogenic edema in the surrounding area. Although there is stable distortion of the third ventricle (rightward shift of 4mm), the lateral ventricles have enlarged slightly and there is slightly greater basal cistern narrowing compared to the prior study. Still no frank brain herniation. 2. Redemonstration of multiple metastatic intraparenchymal brain lesions better visualized on recent MRI examination. No evidence of new parenchymal lesions or sites of hemorrhage. Findings discussed with Dr. Bergl via direct phone call at the time of dictation 5:05 pm 2/22/12. 