 There appear to be six enhancing lesions in the bilateral cerebral hemispheres, the largest of which is located in the left superior frontal gyrus and measures up to 15 mm. Additional lesions are present in the left superior frontal gyrus, right precentral gyrus, left middle temporal gyrus, and right superior and inferior parietal lobules. There is minimal vasogenic edema associated with the lesions, There may also be associated leptomeningeal involvement and faint susceptibility effect within some the lesions, suggestive of microhemorrhage or hypervascularity, for example. There are confluent and punctate T2 hyperintense areas in the periventricular and subcortical cerebral white matter. There are also small areas of encephalomalacia in the right corona radiata, left pons, and left thalamus. The ventricles and sulci are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. There are bilateral lens implants. The skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.
1. Multiple bilateral brain metastasis, without evidence of midline shift.2. Chronic small vessel ischemic disease and chronic lacunar infarcts in the right corona radiata, left pons, and left thalamus.