Clinical question: Evaluate for signs of encephalitis, infection or prior disease. Signs and symptoms: Continued progression of encephalopathy with dystonia and myoclonus. Pre-and post-enhanced brain MRI:Diffusion weighted images are severely compromised due to large metallic fragment/shrapnel artifact obscuring the left hemisphere and the posterior fossa. Beyond the region of artifact no evidence of restricted diffusion.Flair and T2-weighted images are also significantly compromised in particular through the posterior fossa and left temporal secondary to metallic shrapnel artifact.The examination redemonstrates a single punctate focus of flair hyperintensity in the right frontal centrum semiovale similar to prior exam. The anatomical morphology and the signal intensity of brain parenchyma on the artifact remains within normal on all MRI sequences and without interval change. Ventricular system remains within normal and with maintained midline. Lumbosacral cortex, cortical sulci, ventricular system and CSF spaces beyond the artifact.Post enhanced images demonstrate no detectable abnormal parenchymal or leptomeningeal enhancement. The signal void of major intracranial arterial branches are identified.Unremarkable images through the orbits. Note however should be made that there is artifactual T2 hyperintensity of the entire retropatellar space secondary to metallic artifact.
1.No evidence of an acute or new finding since prior exam.2.Single punctate focus of flair hyperintensity in the right frontal centrum semiovale as was noted on prior exam and of no clinical significance.3.Unremarkable and stable pre-and post enhanced brain MRI otherwise as detailed.4.Note should be made that a large artifact secondary to a shrapnel fragment obscures portions of the left hemisphere and posterior fossa as detailed above.