Clinical question: Further assessment for brain metastases and edema. Signs and symptoms: Headache. Pre and post enhanced brain MRI:No diffusion-weighted abnormalities.Examination demonstrate multiple small enhancing metastatic lesions in bilateral hemispheres and a large metastatic necrotic lesion in the right cerebellum.The lesion within the anterior-inferior right cerebellum measures approximately at 22 x 24 mm in transaxial dimensions. It demonstrates extensive surrounding vasogenic edema, mass effect and mild leftward and anterior deviation of fourth ventricle. There is also a large left cerebellar developmental venous anomaly without an associated cavernoma.Multiple small enhancing metastatic lesions in the right cerebellum with the largest measuring approximately at 11 x 8 mm in transaxial dimensions. The lesions demonstrate surrounding vasogenic edema however without mass effect on the ventricular system and no deviation of midline.There is a single necrotic rim-enhancing metastatic lesion in the left posterior parietal measuring approximately 5 x 6 mm in transaxial dimensions. This finding demonstrates minimal surrounding edema.Unremarkable calvarium and orbits without evidence of abnormal enhancement.Unremarkable soft tissues of the scalp, paranasal sinuses and mastoid air cells.
1.Negative diffusion-weighted images. Moderate degree of chronic small vessel ischemic strokes is noted.2.Large necrotic enhancing right cerebellar metastatic lesion measuring at 22 x 25 mm and with mass effect on the fourth ventricle.3.Multiple right hemispheric metastatic lesions largest measuring at approximately 11 x 8 mm. Left hemispheric posterior parietal metastatic lesion measuring 5 x 6 mm in transaxial dimensions.4.No mass effect on the ventricular system and no deviation of midline.5.Unremarkable calvarium, orbits, paranasal sinuses and mastoid air cells.