Reason: posterior reversible encephalopathy syndrome History: seizure MRI of the brainNo diffusion weighted abnormalities are appreciated.There is T2 and flair signal hyperintensity present along the right occipital lobe at the cuneus and along the right parietal lobe at the precuneus and to a much lesser degree scattered along the left precuneus are areas of serpiginous flair signal hyperintensity present within the sulci of the right posterior temporal lobe.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 demonstrate mucosal thickening of the sphenoid sinuses. The visualized portions of the mastoid air cells are opacified. The patient is intubated. The visualized portions of the orbits are intact.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm. There is mild narrowing of the mid basilar artery between the anterior/inferior cerebellar arteries and the superior cerebellar arteries . The right posterior cerebral artery is smaller than the left posterior cerebral artery. There is narrowing and dilations of the basilar artery associated with what appears to be attenuation of the distal posterior cerebral artery branches right more than left To a lesser degree there is suspicion for attenuation of the distal ACA and MCA vasculature. The A2 segment of the anterior cerebral arteries azygos. New right orbitofrontal artery comes off the right A1 segment. The posterior communicating arteries are not readily identified. The left vertebral artery is larger than the right vertebral artery.
1.Findings are suspicious for cerebral infarction involving the right cuneus and precuneus. 2.There is narrowing and dilations of the basilar artery associated with what appears to be attenuation of the distal posterior cerebral artery branches right more than left. To a lesser degree there is suspicion for attenuation of the distal ACA and MCA vasculature. Vasculitis or vasculopathy cannot be excluded.3.Patchy signal changes in the left precuneus are suggestive of a subacute infarction.