Case Notes
History
49 yo female presented with pneumonia but imaging revealed lung cancer. Pt also had weight loss and headaches and increase in unsteadiness.Exam
MR flair
Prior Study
Noncontrast head CT and T2-w spin-echo MR1. Widespread cerebral, cerebellar, and calvarial metastases.
2. The larger right posterior parietal-temporal mets obstruct the right temporal horn (a sequestered ventricle, and produce a midline shift sufficient to cause lateral ventricular hydrocephalus.
3. There is early bilateral uncal and right parahippocampal transtentorial shift.
Sagittal post contrast MR
1. Disseminated brain and calvarial metastases (lung primary)
2. Mass effects have produced subfalcine herniation causing lateral ventricular hydrocephalus, sequestration of the right temporal horn with hydrocephalus and have caused moderately advanced downward transtentorial herniation.