Diagnosis: Transient alteration of awareness. Aphasia Transient alteration of awareness AphasiaClinical question: Evaluate for ischemia, or etiology of seizuresSigns and Symptoms: AMS, possible stroke, seizure No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.There is a moderate degree of periventricular and subcortical confluent hyperintense white matter lesions present identified on the FLAIR and T2 images. Additionally there are patchy and punctate T2 and FLAIR signal hyperintense lesions present in the brainstem, thalami and internal capsules as well as the right cerebellar hemisphere.A punctate focus of susceptibility effect is present along the left thalamus. Another similar lesion is present in the lower pons and upper midbrain, another is located in the right cerebellar hemisphere and one more is located in the left hippocampus.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. The eyeball lenses are thin.
There is no evidence for intracranial mass lesion.1.Periventricular and subcortical white matter lesions of a moderate degree are nonspecific. At this age they are most likely vascular related. 2.Punctate lesions in the brainstem, thalami, internal capsules and right cerebellar hemisphere are also likely vascular related.3.There is no evidence for acute ischemic cerebral infarction.4.Multiple microhemorrhages are identified in the brainstem, cerebellum, left thalamus and hippocampus. This pattern suggests hypertension.