69-year-old woman with history of breast cancer on Eribulin who presents with nausea, vomiting, and fatigue. There are multiple, new enhancing lesions in the calvarium. The largest of these in the left parietal calvarium (11/23) involves both the inner and outer table and measures approximately 19 x 16 x 8 mm. There is no abnormal parenchymal or meningeal enhancement.No restricted diffusion to suggest acute ischemia. Previously seen areas of diffusion restriction infarct in the right precentral and inferior frontal gyri no longer restrict diffusion and there is corresponding volume loss with increased T2 signal compatible with gliosis. Additionally, there is thin, linear susceptibility artifact along the sulci, likely from hemosiderin deposition. There is no intracranial hemorrhage. There is no parenchymal mass or mass-effect. The ventricles are within normal limits in size and configuration. Several foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with chronic small vessel ischemic changes. The brain parenchyma is otherwise unremarkable for age. The major flow-voids are preserved.The sella and orbits are grossly within normal limits. There is mucosal thickening and intermediate signal inspissated mucous within the left ethmoid air cells. The mastoid air cells are clear.
1.New calvarial metastases without evidence of parenchymal or meningeal metastases.2.Evolution of previously seen right frontal lobe infarcts, now chronic with encephalomalacia and gliosis. No evidence of acute infarct or hemorrhage.