51 years Female (DOB:8/27/1964)Reason: NSCLC brain mets. Eval new R frontal lesion in particular. History: brain mets.PROVIDER/ATTENDING NAME: RIMAS V. LUKAS RIMAS V. LUKAS There is redemonstration of a extra-axial fluid collections adjacent to the frontal lobes. The right-sided extra-axial fluid collection adjacent to frontal lobe previously measured 6 mm in thickness and now measures 5 mm in thickness. A multilayered extra-axial fluid collection on the left side currently measures 8 mm in easily measured approximately the same. The extent of these fluid collections are similar between the 2 studies.Metal artifact from aneurysm clips in the right middle cranial fossa obscure visualization of the right anterior temporal lobe and right orbital gyrus on much of the imaging is especially prominent on the susceptibility weighted imaging and diffusion-weighted imaging.There is redemonstration of a focus of T2 and FLAIR signal hyperintensity in the right precentral gyrus measuring 22 x 7 mm axial dimensions. There is an associated 8 mm enhancing nodule on the current exam associated with this which previously measured 3 mm. On the 9/30/2012 exam it also measured approximately 8 mm.Another focus of FLAIR signal hyperintensity is present in the left middle frontal gyrus measuring 12 x 9 mm axial dimensions. There is no associated contrast enhancing lesion is stable compared to the prior exam.There is a lesion in the left cerebellar hemisphere measuring 21 x 23 mm axial dimension on FLAIR imaging which is stable compared to the prior exam. There is a 12 mm x 11 mm enhancing component within this lesion which previously measured 10 mm x 9 mm and in November measured 8 mm x 9 mm. There is a catheter that courses through the left occiput into this lesion with the tip at the left cerebellar medullary angle cistern. This catheter is in stable position.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. Multiple punctate foci of signal loss on susceptibility imaging are redemonstrated in the periventricular white matter and subcortical white matter these were not present on the 9/30/2012 exam.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.There is diffuse pachymeningeal thickening present. This has not changed since prior exam.
1.Extra-axial fluid collections remains stable compared to the prior exam. Associated pachymeningeal thickening remains stable as well.2.There is redemonstration of a left cerebellar lesion whose enhancing component has enlarged relative to the prior exam indicating progression of this particular lesion. A ventricular catheter associated with this lesion is in stable position.3.There is a right precentral gyrus lesion present. The enhancing nodule associated with this lesion is larger on the current exam versus the prior exam. It is suspected to represent metastatic disease which has mildly enlarged since the prior exam.4.A left middle frontal gyrus lesion predominantly involving subcortical white matter is stable.5.Periventricular and subcortical white matter signal changes of a mild degree are present which are nonspecific. They could be vascular related, related to demyelination, trauma, vasculitis, sarcoid. They are nonspecific. 6.Periventricular microhemorrhages are present. These are nonspecific. It is possible they are treatment related.7.Metal artifact partially obscures the anterior aspect of the right temporal lobe and the right orbital gyrus. Lesions in these locations would be difficult to detect.8.Status post right craniotomy for aneurysm clipping.