 Again seen is left parietal intraparenchymal hematoma measuring 3.4 x 3.0 cm with adjacent edema similar to recent CT. There is FLAIR hyperintensity in the left frontal lobe involving the left middle frontal gyrus with suggestion of volume loss, which may be related to prior infarct. There is also additional scattered increased T2/FLAIR signal abnormality in the bilateral subcortical and periventricular white matter which are nonspecific but compatible with chronic small vessel ischemic disease. There are multiple abnormal areas of leptomeningeal enhancement within the left frontal lobe along the left middle frontal gyrus as well as inferiorly, left parietal lobe, left inferior temporal lobe, left posterior temporal and left occipital lobes. These findings are concerning for leptomeningeal metastatic disease. There is abnormal enhancement associated with the left parietal hematoma. There is linear areas of enhancement and susceptibility effect in the left superior parietal lobule and left temporo-occipital lobes likely representing leptomeningeal tumor with blood products. Major flow-voids are preserved. No midline shift or herniation. Calvarium is intact.
1.There are multiple abnormal areas of leptomeningeal enhancement within the left frontal lobe along the left middle frontal gyrus as well as surfaces of the inferior frontal lobe, left parietal lobe, left posterior temporal and left occipital lobes. There is susceptibility effect in some of these areas compatible with chronic blood products. Findings are suspicious for leptomeningeal metastatic disease. 2.Stable left parietal intraparenchymal hematoma with abnormal associated enhancement which is at least predominantly leptomeningeal. No additional foci of abnormal intraparenchymal enhancement are definitively appreciated. 3.Probable chronic infarct in the left frontal lobe.