81 years, Female, weakness, history of non-small cell lung cancer. There is a 15 x 11 x 15 mm (AP x transverse x craniocaudal dimensions) expansile enhancing mass in the right aspect of the medulla. There is surrounding vasogenic edema involving the bilateral aspects of the medulla and extending slightly into the right pons. There is minimal susceptibility effect suggesting minimal hemorrhage within the lesion.There is a 3 mm enhancing nodule in the right internal auditory canal.There is an area of susceptibility effect along the gyri in the left paramedian parietal lobe involving the precuneus, with mild enhancement and increased vascularity in this region, indicating prior subarachnoid hemorrhage. There is also intraparenchymal focus of hemorrhage involving the posterior aspect of the left cingulate gyrus. There is a 3 mm focus of enhancement along the cortical surface in this region but otherwise no discrete mass is appreciated.No restricted diffusion to suggest acute ischemia. Aside from the right medullary lesion there is no large intracranial mass or evidence of mass effect, midline shift, or herniation. No hydrocephalus. There is prominence of the extra-axial spaces along the bilateral cerebral convexities likely reflecting volume loss and perhaps small chronic subdural effusions, relatively larger on the right, without focal mass effect and similar to prior CT from 6/14/2012. Several foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with mild chronic small vessel ischemic changes. Major flow-voids are preserved. No discrete enhancing lesions are seen in the calvarium or extracranial soft tissues.
1. 15 x 11 x 15 mm enhancing mass in the right aspect of the medulla with surrounding vasogenic edema suspicious for metastasis.2. 3 mm enhancing nodule in the right internal auditory canal may represent an incidental vestibular schwannoma although additional focus of metastasis is not excluded.3. Evidence of subacute to chronic intraparenchymal and subarachnoid hemorrhage in the left paramedian parietal lobe. There is a 3 mm focus of enhancement along the cortical surface in this region which may be secondary to the hemorrhage or represent an underlying lesion. There is increased vascularity in this region and underlying vascular lesion is not excluded.Dr. Ali communicated findings to Dr. Patel via email on 10/8/2016 at the time of this report.