Diagnosis: Dysphagia, unspecified WeaknessClinical question: met ovarian cancer with swallowing difficulty, eval for leptomeningeal diseaseSigns and Symptoms: met ovarian cancer with swallowing difficulty, eval for leptomeningeal disease MRI brain:There is a small hemorrhagic focus present along the medial aspect of the left temporal lobe which is hypointense on susceptibility weighted imaging and measures 3 mm on T2-weighted imaging. It is associated with contrast enhancement.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.MRI cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. No abnormal enhancing lesions are identified in the cervical spine.At C2-3 there is no significant compromise to the spinal canal or neural foramina. There is a small left lateral recess disc protrusion present at this level.At C3-4 there is no significant compromise to the spinal canal. There is a small left lateral recess disc protrusion present at this level which mildly encroaches on the nerve roots at the left lateral recess.At C4-5 there is no significant compromise to the spinal canal or neural foramina.At C5-6 there is no significant compromise to the spinal canal or neural foramina.At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.
1.There is a small hemorrhagic lesion present along the medial aspect of the left temporal lobe which is too small to characterize further the possibility this represents metastatic disease cannot be excluded2.There are some degenerative changes present in the cervical spine associated with some small disc protrusions in the upper cervical spine and some mild encroachment of the left-sided exiting nerve roots at C3-4.