 There is approximately 22 x 22 mm transaxial dimension lesion at the left parieto-occipital junction, demonstrating a fluid-heme level. Contents anteriorly are T1 and T2 hyperintense, most consistent with extracellular methemoglobin. Posteriorly, contents are somewhat mixed between isointense and hyperintense on T1 and hyperintense on T2 suggesting a mixture of intracellular deoxyhemoglobin and intracellular met hemoglobin. Far posteriorly, there is a small area with susceptibility and enhancement which may suggest a small vascular nidus. There is mild regional mass effect upon sulci. There is no resulting midline shift.There are scattered foci of T2 hyperintensity in the white matter without restricted diffusion, mass effect, susceptibility abnormality, or enhancement representing mild chronic small vessel ischemic diseaseThe ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. The pituitary gland is normal in size. There is no acute cerebral, brainstem or cerebellar infarction. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. Mucosal thickening is present within bilateral maxilla sinuses, and fluid is noted within a few dependent mastoid air cells.
There is approximately 22 x 22 mm transaxial dimension hemorrhagic lesion at the left parieto-occipital junction. Far posteriorly, there is a small area with susceptibility and enhancement which may suggest a small vascular nidus. There is mild regional mass effect upon sulci. There is no resulting midline shift. Given patient age and history of urothelial cancer, this most likely represents a hemorrhagic metastasis, with other etiologies considered less likely.