80 years Male (DOB:3/16/1936)Reason: Metastatic lung cancer, evaluate brain mets History: memory impairmentPROVIDER/ATTENDING NAME: JYOTI D PATEL JYOTI D PATEL The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. Compared to the prior exam from 5/27/2015 there are more subcortical white matter lesions on the current exam especially in the right frontal lobe and right parietal lobe subcortical white matterThere is a subdural effusion the posterior fossa which is likely related to atrophy and has not changed substantially compared to prior exam.At T2 hyperintense and FLAIR hypointense lesion is present in the left paramedian pons which is unchanged since the prior exam.No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.There is a 14 x 21 mm axial dimension enhancing focus present adjacent to and medial to the left lateral pterygoid musculature which is suspected to represent venous plexusNormal 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 demonstrate some small mucous retention cysts.. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. The right eyeball lenses is thin.
1.Periventricular and subcortical white matter lesions of a mild to moderate degree are nonspecific. At this age they are most likely vascular related. Since the prior exam there are more than of accumulated in the right hemisphere.2.Old lacunar infarct involving the left paramedian pons.3.There is no evidence for brain metastases on the basis of this exam.4.A lesion in the left pterygoid musculature is suspected to be related to pterygoid venous plexus