Diagnosis: Secondary malignant neoplasm of brain and spinal cordClinical question: characterization of brain metsSigns and Symptoms: gait instability, newly diagnosed lung cancer There is an 18 x 24 mm axial dimension mass redemonstrated at the left cerebellopontine angle cistern which is associated with some adjacent dural thickening and has a broad-based towards the dura. Some susceptibility effect is associated with this lesion suggesting blood products lesion. It appears to have partial extra-axial location and may be exophytic from the adjacent cerebellumThere is a 6 x 8 mm axial dimension enhancing lesion present at the periphery of the left cerebellar hemisphere which was also present on the prior exam and is associated with susceptibility effect.There is redemonstration of a 16 x 21 mm sagittal dimension and 16 x 21 mm axial dimension ring-enhancing mass centered in the right cingulate gyrus which is associated with adjacent vasogenic edema and has also not changed substantially compared to the previous exam and is associated with susceptibility effectThere is a 3 mm enhancing focus in the right cerebellar hemisphereNormal 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 partial opacification of the left frontal sinus The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. The eyeball lenses are thin.
There are multiple hemorrhagic intracranial lesions present which are stable compared to prior exam. One in the left cerebellopontine angle cistern appears to be exophytic. There are others in the left cerebellar hemisphere and right cingulate gyrus. Metastatic disease is not most likely consideration under the circumstances.