Confusion, lethargy, and dysarthria. History of cecal cancer and multiple myeloma. There are a few supratentorial and infratentorial punctate foci of high T2 signal and enhancement, including within the cerebellar vermis, right cerebellar tonsil, and right occipital lobe, right parietal lobe, and left insula. which appear to be new. Otherwise, scattered foci of high T2 signal in the supratentorial and infratentorial white matter are unchanged. There is no evidence of intracranial hemorrhage. There is diffuse mild thickening and prominent enhancement of the dura. The ventricles and basal cisterns are unchanged in size and configuration. There is a partially empty sella. There is no midline shift or herniation. There is mild vertebrobasilar dolichoectasia. There is an unchanged prominent left occipital lymph node. The orbits, skull, and paranasal sinuses are grossly unremarkable.
1. Punctate enhancing supratentorial and infratentorial lesions appear to be new and may represent metastases or perhaps an inflammatory process. Otherwise, scattered foci of high T2 signal in the supratentorial and infratentorial white matter are unchanged and may represent chronic small vessel ischemic disease and there is no evidence of acute infarction. 2. Diffuse mild thickening and prominent enhancement of the dura may be due to intracranial hypotension or recent lumbar puncture. 