Innumerous brain metastases
Worsening headache and nausea over a week. Hx of breast cancer.
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There are innumerable small enhancing lesions throughout both cerebral and cerebellar hemispheres and brainstem. Vasogenic edema is seen associated with the larger of these lesions. Several of these lesions appear to be mildly hemorrhagic, particularly in the right tectal plate and right posterior frontal lobe. There is no hydrocephalus or midline shift. No acute cortical infarct or intracranial hemorrhage. Opacification of left mastoid air cells. The imaged paranasal sinuses are aerated. No suspicious bony lesion.
Substantial burden of intracranial metastatic disease.
Great illustration of how a non contrast CT head can significantly downplay the extent of intracranial metastases.