Presentation
Right-sided weakness and dragging off his right foot.
Patient Data
Non-contrast CT head revealed multiple dense mass lesions within both cerebral hemispheres, midbrain and left cerebellar hemisphere. The largest lesion is at the right basal ganglia with surrounding hypodense vasogenic edema.
Pre and post-contrast MRI head revealed multiple heterogeneously enhancing masses scattered throughout the cerebral, cerebellar hemispheres and midbrain. Some of these lesions show foci of T1 hyperintensity in keeping with hemorrhage. Perilesional vasogenic edema. The right basal ganglia lesion causing a mild mass effect on the ipsilateral lateral ventricle. The right tectal lesion mildly compresses the cerebral aqueduct. No midline shift or significant hydrocephalus.
Right upper lobe irregular mass lesion with right hilar and mediastinal lymphadenopathy.
Case Discussion
Right upper lobe endo-bronchoscopic biopsy revealed poorly differentiated adenocarcinoma
CT and MRI imaging revealed multiple intracranial metastases in both supra and infratentorial compartments and associated perilesional edema, some of them are hemorrhagic metastases.
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