Diagnosis: Other symptoms involving nervous and musculoskeletal systems(781.99)Dysphagia, unspecified(787.20)Clinical question: alteration in mental status, aphasia, concern for ICH vs massSigns and Symptoms: AMS Since the prior exam the patient has developed additional foci of diffusion restriction. Whereas previously they were more punctate and to a large degree involved watershed zones and cerebellum and patchy foci in the occipital lobes, there is now a larger area of diffusion restriction involving left middle and inferior frontal gyri and another new focus in the medial left occipital lobe involving calcarine cortex.Associated contrast enhancement with some of the infarction has evolved along some of the prior infarctions.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 a small mucous retention cyst in the right maxillary sinus. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.
1.Since the prior exam the patient has developed new foci of infarction involving the left frontal lobe and left occipital lobe as described above in addition to multiple foci of infarction as described above. Please note that some of the areas of infarction are associated with contrast enhancement which is likely related to subacute phase of infarction which is associated with breakdown of the blood brain barrier. This is supported by the evolution of contrast enhancement since the prior exam.