Altered mental statusClinical question: acute brainstem ischemiaSigns and Symptoms: episode of unresponsiveness There is generalized brain atrophy present with some disproportionate enlargement of the lateral ventricles relative to the sulci.There is a moderate degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. Additional high signal foci on T2 and FLAIR MRI are present in the thalami and brainstem.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.
1.Periventricular and subcortical white matter changes of a moderate degree are nonspecific. At this age they are most likely vascular related. Another possibility is it is related to no degenerative process. 2.A moderate degree of Lesions present in the thalami and brainstem are also likely vascular related.3.There is no evidence for acute ischemic cerebral infarction appreciated.4.Ventriculomegaly is a nonspecific finding. Although this could be related to atrophy, it could also be related to normal pressure hydrocephalus.5.Examination is somewhat degraded by patient motion. This may obscure more subtle abnormalities.