45 years Female (DOB:10/4/1970)Reason: pre-op planning History: new cerebellar lesion, needs ORPROVIDER/ATTENDING NAME: DOROTA K HAVLIN EDWIN RAMOS There are multiple enhancing lesions present within the brain parenchyma. These are predominantly located in the posterior fossa. One in the lower half of the left cerebellar hemisphere is actually to combined lesions and measures 36 x 23 mm axial dimensions. One in the medial aspect of the right cerebellar hemisphere measures 28 x 29 mm axial dimensions. One in the pons measures 10 x 16 mm axial dimensions. One in the medial right occipital lobe measures 8 x 6 7 mm axial dimensions. One in the right centrum semiovale measures approximately 5 mm in diameter. One in the left frontal lobe in the middle frontal gyrus measures 9 mm diameter. One in the left inferior frontal gyrus measures 5 mm diameter. There is some vasogenic edema associated with some of these lesions especially the larger 1's. There is associated mass effect in the posterior fossa with compression of the fourth ventricle displacement of the cerebellar tonsils through the foramen magnum and compression of the brainstem against the clivus. There is associated ventriculomegaly.The patient is status post left frontal craniotomy.Incidental note is made of a developmental venous anomaly in the right frontal lobe.The calvarium has a mottled appearance with foci of the marrow replacement.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.There are multiple lesions compatible with metastatic disease scattered within the brain parenchyma is detailed above. The largest lesions are located in the posterior fossa where there is significant mass effect with foramen magnum herniation and compression of the brainstem as well as compression of the fourth ventricle with associated ventriculomegaly.2.There are findings consistent with a calvarial marrow replacement. Possibility of bone metastases cannot be excluded. Perhaps a bone scan may be helpful.