80 year-old female with history of metastatic breast cancer. Evaluate for metastatic disease. There are diffuse areas of decreased signal abnormality present within the calvarium and visualized cervical vertebrae likely secondary to extensive sclerotic osseous metastasis. There is an enhancing mass occupying the left occipital condyle. Furthermore, there is a briskly enhancing nodule present just inferior to the left transverse sinus involving the paramedian occipital bone with dural and probable intradural components. It is difficult to assess whether this nodule invades the transverse sinus. There is no evidence of surrounding parenchymal abnormality.There is no evidence of intracranial hemorrhage or acute ischemia. There are scattered foci of T2/flair hyperintensity within the periventricular and subcortical white matter. There are no areas of abnormal parenchymal enhancement. The ventricular configuration is age appropriate. The orbits are unremarkable. The visualized paranasal sinuses and mastoid air cells are clear. Normal intracranial that flow voids are present.
1.No evidence of metastatic disease to the brain parenchyma.2.Diffuse osseous metastatic disease as above.3.Briskly enhancing nodule adjacent to the left transverse sinus with osseous, dural and probable intradural extension, also likely representing a metastatic lesion given the context. An atypical meningioma or hemangiopericytoma may also be considered in the differential.4.Scattered foci of T2/flair hyperintensity within the periventricular and subcortical white matter likely represents chronic small vessel ischemic disease.