Diagnosis: Malignant neoplasm of unspecified part of right bronchus or lung Malignant neoplasm of unspecified part of right bronchus or lungClinical question: r/o brain metsSigns and Symptoms: altered mental status, SCLC The CSF spaces are appropriate for the patient's stated age with no midline shift. There are patchy foci of signal hyperintensity on FLAIR and T2 MRI located in the brainstem.There are several punctate FLAIR and T2 hyperintense lesions present within the basal ganglia identified.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.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 demonstrate partial opacification of the mastoid air cells. The visualized portions of the orbits are intact. The eyeball lenses are thin.
1.Patchy lesions in the brainstem and punctate lesions in the basal ganglia are likely vascular related.2.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related. 3.No evidence for brain metastases.