Head ache, imbalance.
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Multiple discrete intracranial intra-axial lesions are demonstrated of variable appearance. Some are cystic with mural enhancing nodule (left frontal), others are haemorrhagic and enhancing (right frontal), others are small and uniformely enhancing, whilst the cerebellar lesions shows only peripheral signal loss and central intrinsic high T1 and T2 (extra-cellular met haemoglobin) / altered blood products.
The appearances are those of haemorrhagic metastases, and the variety of appearance favours malignant melanoma.
The patient went on to have the left cerebellar and right frontal lesions excised (at two separate times), both of which confirmed the diagnosis of melanoma.