PMC5894122_01
Brain CT performed after one day since onset of neurological symptoms: (A) before and (B) after contrast administration. A hyperdense lesion can be observed in the cortex of the left parietal gyrus.
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They were interpreted as calcifications or haemorrhagic strokes (Figure 1).
Brain MRI performed after 4 days since onset of neurological symptoms; before contrast administration: (A) T1-weighted, (B) T2-weighted, (C) FLAIR, (D) DWI-EPI, (E) ADC map images; (F) T1-weighted axial images after contrast administration. On T2-weighted and FLAIR images, a hyperintense lesion can be observed in the left parietal cortex; the lesion displays features of restricted diffusion, signal increase on DWI-EPI sequence and signal decrease on ADC map. There was no change in signal intensity after administration of contrast.
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Taken together, such radiological features indicated the presence of multiple acute and subacute ischaemic lesions (Figure 2).
Brain MRI perforemed sixteen days since onset of neurological symptoms; before contrast administration: (A) T1-weighted, (B) T2-weighted, (C) FLAIR, (D) DWI-EPI, and (E) ADC map images; (F) T1-weighted axial image after administration of contrast. On T2-weighted and FLAIR images, hyperintense foci can be observed in the left parietal cortex, together with new foci in the right frontal cortex and both parietal regions. On DWI, restricted diffusion is seen in both brain hemispheres. Signal intensity of the described lesions increased homogeneously after administration of contrast.
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Because a typical evolution of ischaemic lesions in DWI sequences was not observed, contrast enhancement in multiple lesions was observed, and the patient had lung cancer, we diagnosed cerebral metastases (Figure 3).