Metastatic tonsil squamous cell carcinoma to the brain status post resection and post-operative SRS: surveillance MRI. There are post-treatment findings in the left temporal region without gross residual tumor in the treatment bed. However, there are several new punctate enhancing lesions in the right frontal lobe. Furthermore, there has been interval increase in size of the left occipital lobe and right precentral gyrus lesions, measuring 6, 9, and 15 mm, previously 5, 6, and 12 mm, respectively. There are punctate foci of restricted diffusion and high T2 signal in the left cerebellar hemisphere and left supramarginal gyrus region. There is an unchanged punctate focus of susceptibility effect in the right centrum semiovale. There is no evidence of acute intracranial hemorrhage. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, paranasal sinuses, and scalp soft tissues are unchanged.
1. Interval increase in size and development of new intracranial metastases. Otherwise, no evidence of residual tumor in the left temporal lobe treatment bed.2. Punctate foci of restricted diffusion in the left cerebellar hemisphere and left supramarginal gyrus region likely represent recent infarcts. 