50 -year-old male with metastatic melanoma with multiple brain metastases and intracranial hemorrhage. There is no significant interval change in the size of the left thalamic hematoma to the 2.8 x 2.1 x 3.7 cm (AP x TR x CC image 14; series 4) from 2.7 x 2.2 x 3.4 cm. The hematoma extends into the midbrain. There is no significant interval change in the amount of vasogenic edema in the surrounding area even allowing for technique differences: Edema and hematoma measure together 4.2 cm in diameter (15; series 4), previously 4.2 centimeters. There is mass effect on the superior cerebellar peduncle as well as the fourth ventricle. Additionally, there is distortion and rightward displacement of the third ventricle which is stable. There is no significant interval change in the previously described slight enlargement of the lateral ventricles bilaterally. The temporal horn of the left lateral ventricle measures 9 mm, previously 9 mm. There is narrowing of the basal cisterns which appears unchanged when compared to the previous study. There is no evidence of frank brain herniation. There is no evidence of extra-axial fluid collection. Multiple mass lesions within the cerebral hemispheres are noted, some of them hyperdense consistent with petechial hemorrhage or mineralization. Findings are consistent with known metastatic lesions and appear grossly stable. The area of dominant left frontal lobe and right cerebellar hypoattenuation also appear grossly similar to the recent brain MRI. No new parenchymal lesions or hematomas are noted. The visualized mastoid air cells and paranasal sinuses are clear. The visualized orbits are unremarkable.
1. No significant interval change in left thalamic hematoma with extension into the midbrain. No significant interval change in the amount of vasogenic edema in the surrounding area. Stable distortion of the third ventricle and stable enlargement of the lateral ventricles bilaterally without evidence of frank brain herniation. 2. Redemonstration of multiple metastatic intraparenchymal brain lesions better visualized on recent MRI examination. No evidence of new parenchymal lesions or sites of hemorrhage. 