Mesothelioma. Increased confusion. The exam is limited by patient motion. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is mild nonspecific cerebral white matter T2 hyperintensity, which may represent chronic small vessel ischemic disease. There are also unchanged nonspecific areas of high T2 signal within the bilateral basal ganglia, which may also represent chronic ischemic lesions. There is no abnormal intracranial enhancement. There is diffuse cerebral volume loss. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits are grossly unremarkable. There is a small left maxillary sinus rentention cyst. There is a punctate enhancing lesion in the left temporal scalp.
1. No definite evidence of intracranial metastases, although the exam is limited by patient motion. 2. A punctate enhancing lesion in the left temporal scalp is nonspecific and may represent an inflammatory process or neoplasm, including metastatic disease.