Malignant neoplasm of breast (female), unspecified site [174.9], Reason for Study: ^Reason: altered mental status History: fatigue There are multifocal various sized bihemispheric supra and infratentorial mainly gyriform enhancing lesions. In addition, there are some parenchymal nodular enhancing lesions such as right periventricular white matter and bilateral anterior temporal lobes. Dominant gyriform enhancing lesions as well as some nodular lesions are associated with surrounding edema without evidence of hemorrhage. There is no evidence of restricted diffusion.The location and MR characteristics of these lesions are suggesting the possibility of inflammatory or infectious lesions instead of tumorous condition. Since clinical history does not suggest abrupt development of symptoms, thus the possibility of vascular lesion would be less likely. Thus, diagnostic possibilities include toxic/metabolic lesions possibility related to the patient's prior or recent chemotherapy, paraneoplastic syndrome, PRES or unusual infectious condition. Possibility of neoplastic/metastatic origin would be lower.There is no evidence of acute ischemic or hemorrhagic lesion.The ventricles, sulci and cisterns are symmetric and unremarkable. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.
1. Multifocal mainly gyriform enhancing lesions associated surrounding edema as described above. No evidence of acute ischemic or hemorrhagic lesion.2. Diagnostic possibilities include inflammatory or infectious lesions instead of tumorous condition. Since clinical history does not suggest abrupt development of symptoms, the possibility of vascular origin lesion would be lower.