Clinical question: Lung cancer, right arm weakness. Signs and symptoms: Right arm weakness. Pre and post enhanced brain MRI:No acute intracranial process and negative diffusion weighted series.There is a new ring-enhancing lesion with subtle surrounding edema consistent with a metastatic lesion in the right cerebellum measuring approximately at 5.5 mm.An additional tiny focus of enhancement in the right anterior temporal lobe measures approximately at 5 mm is also noted. This finding demonstrate no associated edema or mass effect.Additional cortical based ring-enhancing lesion in the right precentral virus measuring approximately at 9 mm without surrounding vasogenic edema or appreciable mass effect.There is no detectable leptomeningeal enhancement.Unremarkable cerebral cortex, cortical sulci, ventricular system and CSF spaces are otherwise. Minimal periventricular and multiple tiny foci of FLAIR hyperintensity in the subcortical white matter of bilateral cerebral hemispheres are suggestive of mild chronic small vessel ischemic strokes without significant change since prior exam.Calvarium and soft tissues of the scalp are unremarkable.Unremarkable images through the orbits and including axial fat sat post enhanced series.Unremarkable all visualized paranasal sinuses and bilateral mastoid air cells and middle ear cavities.
1.Multiple new small supratentorial and infratentorial metastatic lesions as detailed/measured above.2.No evidence of intracranial hemorrhage or significant vasogenic edema/mass effect.3.Unremarkable calvarium, orbits, paranasal sinuses and mastoid air cells.