56 years Male (DOB:9/1/1959)Reason: History of Brain mets please compare. 3 large ones treated with SRS History: NonePROVIDER/ATTENDING NAME: STEVEN J. CHMURA STEVEN J. CHMURA The CSF spaces are appropriate for the patient's stated age with no midline shift. Since the prior exam the left cerebellar lesion has decreased in size from 6 x 4 mm to 4 x 2.5 mm axial dimensions. A right middle cerebellar peduncle lesion measuring 2 mm is unchanged. The lesion adjacent to the dura of the left tentorial leaf adjacent to the left cerebellar hemisphere currently measures 9 x 5 mm and previously measured 11 x 7 mm the lesion in the right temporal lobe posteriorly measures 4 mm on the current exam and located along the collateral sulcus. It previously measured the same lesion adjacent to the dura broad-based the dura is present which previously measured 5 x 5 mm and now measures 7 x 9 mm axial dimensions. The lesion along the medial aspect of the right parietal lobe currently measures 6 x 6 mm and previously measured 6 x 6 mm. An extra-axial left middle frontal gyrus lesion is not readily identified on the current exam.There is redemonstration of a prior ventriculostomy tract through the right frontal lobeWithin the scalp soft tissues is redemonstration of a 32 x 6 mm subgaleal lipoma.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. 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 demonstrate a mucous retention cyst in the right maxillary sinus. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.
1.There are multiple brain lesions scattered in both hemispheres as well as the posterior fossa some which are intraparenchymal and some which are extra-axial which are compatible with metastatic disease. There is a mixed response to treatment with some lesions being smaller on the current exam and others being larger as detailed above, however, overall there appears to be a overall decrease in the amount of metastatic volume.2.Periventricular and subcortical white matter lesions of a mild degree are nonspecific. They're stable since the prior exam.