History of metastatic renal cell cancer, now with new onset double vision. The enhancing lesion in the left parietal lobe is unchanged, measuring up to 6 mm, previously also 6 mm. Likewise, the associated minimal confluent surrounding T2 hyperintensity has not significantly changed. The enhancing right inferior temporal gyrus lesion is unchanged in size, measuring up to 4 mm, previously also 4 mm. There is unchanged nonspecific mild, predominantly periventricular, cerebral white matter T2 hyperintensity. There is no evidence of intracranial hemorrhage or acute infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is minimal fluid in the mastoid air cells and retention cyst formation in the maxillary sinuses.
1. No significant interval change in size of the left parietal and right temporal lobe metastases.2. No evidence of new intracranial metastases or acute infarction.3. The orbits appear to be grossly unremarkable. However, dedicated orbital imaging may be useful for evaluating the symptomatology.