35 years, Female, confusion, rule out leptomeningeal disease. Bladder cancer. There are multiple foci of T2/FLAIR hyperintensity in the bilateral subcortical and periventricular white matter as well as few which are infratentorial including in the left cerebellar hemisphere and middle cerebellar peduncle. A punctate focus of restricted diffusion is present in the right corona radiata near the junction with the right internal capsule and was evident on recent MRI from 6/13/2016. Additional foci of mild diffusion restriction correspond to some of the foci of T2/FLAIR hyperintensity mentioned above. Compared to 5/5/2016, there has been evolution of the prior foci of restricted diffusion and development of new foci of restricted diffusion.No intracranial hemorrhage. No intracranial mass or mass-effect. Unchanged appearance of the ventricular system including the lateral ventricles which are mildly dilated. Diffuse thinning of the corpus callosum is again seen.No abnormal parenchymal or meningeal enhancement. Major flow-voids are preserved. Mild right maxillary sinus mucosal thickening and small bilateral maxillary retention cyst. Calvarium and remainder of the extracranial soft tissues are grossly unremarkable.
1. There is no abnormal leptomeningeal or parenchymal enhancement on the current study. No evidence of metastatic disease. 2. Compared to prior MRI from 5/5/2016 there has been evolution of the prior scattered foci of restricted diffusion and development of new foci of restricted diffusion, findings which are compatible with multiple small infarcts.3. Please note prior studies have been significantly motion degraded and is unclear how much of the enhancement on prior MRI study from 5/5/2016 is artifactual. Presuming an interval improved pattern of enhancement, infectious/inflammatory process remains a possibility. Parenchymal foci of enhancement observed on prior study may also conceivably represent subacute infarcts. Would suggest correlation of above findings with CSF analysis.