History of thyroid cancer with intracranial metastases. Follow-up exam. New punctate focus of restricted diffusion in the left cerebellar hemisphere without associated T2 abnormality compatible with an acute to subacute infarct.Again seen is a peripherally enhancing focus of susceptibility in the left paracentral lobule with associated surrounding increased T2 signal. There appears to be a mild decrease in the degree of peripheral enhancement, and the surrounding edema is not significantly changed.Again seen are multiple foci of enhancement in the frontal lobes bilaterally and anterior right temporal lobe. Most of these lesions appear slightly increased in size. For example, the most superior left frontal lobe lesion measures 4 mm (series 1/2/2001 image 120), previously 2 mm. In addition there are new punctate foci of enhancement in the right caudate head and left frontal orbital gyrus which were not clearly present on the prior exam. No significant associated mass effect, midline shift, or herniation.The ventricles and basal cisterns are normal in size and configuration. The expected intracranial vascular flow voids are present. The paranasal sinuses are clear. Unchanged bilateral partial mastoid air cell opacification. The orbits are unremarkable.
1. New punctate left cerebellar acute to subacute ischemic infarct.2. Mild interval increase in size and number of punctate enhancing foci in the bilateral frontal lobes, right basal ganglia, and right temporal lobe compatible with progression of metastatic disease.3. Mild interval decrease in peripheral enhancement associated with the left paracentral lobule cavitary lesion.Findings were discussed with Dr. Mark Belkin p1002 of the inpatient service at the time of dictation.