Clinical question: Evaluate for etiology of breakthrough seizure. Signs and symptoms: Breakthrough seizures, patient has known metastatic esophageal cancer with left brain met. Pre-and post-enhanced brain MRI:Examination demonstrates no evidence of an acute intracranial hemorrhage, midline shift or hydrocephalus.A necrotic rim enhancing tumor in the left post central gyrus is again identified. It measures at 13.8 x 14.4 x 16.7-mm and demonstrates very subtle interval increased size since prior study measurement of 13 x 14.8 X 15.6-mm. Large focus of surrounding vasogenic edema demonstrates no significant change since prior exam and results in regional mass-effect without mass effect on the lateral ventricle or midline shift.There is no detectable additional foci of parenchymal or leptomeningeal enhancement.Finding suggestive of mild chronic non-hemorrhagic small vessel ischemic strokes are again noted and diffusion-weighted images are negative.Calvarium and soft tissues of the scalp are unremarkable and without abnormal enhancement.Unremarkable images through the orbits and included axial fat sat post enhanced series. Excellent all paranasal sinuses and bilateral mastoid air cells and middle ear cavities demonstrate normal pneumatization signal patterns.
1.No detectable acute intracranial process. 2.Left post central gyrus rim enhancing metastatic lesion demonstrates subtle interval increased size (likely as result of treatment) however with stable surrounding vasogenic edema with resultant regional mass-effect and no midline shift.3.Negative diffusion weighted images and finding suggestive of mild chronic small vessel ischemic strokes