56 years Female (DOB:10/25/1959)Reason: Evaluate for metastatic disease - 56 yo F with BRCA1 mutation, R Breast cancer with nodal mets now w/ 2 weeks nausea, vomiting, diffuse weakness w concern for cord compression and hypodensity in R posterior parietal lesion on CT head after fall 1 wk ago History: nausea, emesis, abnormal CT head with hypodense lesion in R posterior parietal regionPROVIDER/ATTENDING NAME: CHRISTOPHER K DAUGHERTY CHRISTOPHER K DAUGHERTY There are multiple enhancing lesions scattered throughout the brain parenchyma. There is an irregularly shaped ring-enhancing mass centered in the right inferior parietal lobule measuring 38 x 21 mm axial dimensions which is associated with some adjacent leptomeningeal and dural thickening. There are some associated punctate foci of signal loss and susceptibility imaging within this lesion which may represent microhemorrhage. There is another ring-enhancing irregularly shaped mass centered along the left para hippocampal gyrus measuring 16 x 21 mm axial dimensions. There is an enhancing nodule present in the right cerebellar hemisphere measuring 4 mm. There is leptomeningeal enhancement within the posterior fossa and along the supratentorial brain posteriorly.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.
1.There is leptomeningeal disease predominantly involving posterior fossa and the posterior aspect of the supratentorial brain present which in the setting of breast cancer is suggestive of leptomeningeal carcinomatosis.2.There are multiple brain parenchymal lesions present in the right parietal lobe and left temporal lobe as well as the cerebellum which are compatible with brain metastases.