Diagnosis: Secondary malignant neoplasm of brainClinical question: eval for intracranial cause for AMS, metastatic esophageal SCCSigns and Symptoms: non-participatory with exam, obtunded stateComments: Stereotactic radiosurgery 2014, but many previous MRI brain as early as this year Foci of diffusion restriction are present along the globus pallidus bilaterally as well as in the periventricular and subcortical white matter as well as the left cerebellar hemisphere. There is a new focus of diffusion restriction present adjacent ot the deep gray nuclei of the right cerebellar hemisphere. It is located immediately anterior to the location of a previously treated ring-enhancing lesion associated with some susceptibility effect. The appearance of the previously treated lesion remains stableThere is a focus of abnormal heterogeneous signal present along the left cuneus and precuneus associated with susceptibility effect and an adjacent burr hole where there is previously a metastatic lesion. There are associated T2 and FLAIR signal hyperintensity in the adjacent white matter. There is no associated asymmetric ex vacuo effect present. Compared to the prior exam from 9/11/2015 there is not appear to be a substantial change.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 are multiple subcentimeter infarcts present in the globus pallidus bilaterally and right cerebellar hemisphere associated with punctate periventricular and subcutaneous cortical microinfarcts and microinfarction the left cerebellar hemisphere.2.A hemorrhagic lesion is present in the left cuneus and precuneus. The possibility that there is recurrent tumor cannot be excluded. Another possibility is that this could represent radiation necrosis. Please note that no post contrast imaging was performed.3.A right cerebellar hemisphere lesion is unchanged since the prior exam and also likely represents previously treated metastasis.