MRI brain requested by the neurologist because of the facial nerve palsy and mental status changes of the patient.
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There is an oval extra-axial expansive lesion in the posterior cranial fossa, adjacent to the posterior lobe of the right cerebellar hemisphere, with mild compressive effect to the adjacent parenchyma. The lesion is isointense on T1W, T2W, and FLAIR, with intensive homogeneous post-contrast signal intensity enhancement.
There are also multiple punctiform and lacunar old ischemic lesions suporatentorialy and also in the pons on the left, with massive periventricular ischemic leukoencephalopathy.
This patient's symptoms are probably due to multiple ischemic lesions and hypertensive leukoencephalopathy.
The patient was referred to a neurosurgeon and further neuroradiological follow-up is advised.