Altered mental status [780.97], Reason for Study: ^Reason: concern for SC abscess History: concern for SC abscess Brain MRI:Multifocal restricted diffusion lesions on bilateral frontal lobes, left frontal, parietal and temporal lobes. In addition, there are restricted diffusion lesions on bilateral mesial thalami, left basal ganglia, bilateral mesial hippocampi, bilateral midbrain, posterior aspect of pons and medulla, cerebellar vermis and bilateral mid-cerebellar peduncle. The right hemispheric subacute to early chronic ischemic infarction lesions show usual evolution including encephalomalacia with minimal mass effects toward right lateral ventricle. There are multifocal petechial signal voids within the right MCA ischemic lesion indicating hemorrhagic conversion.Mucosal thickenings on bilateral maxillary sinuses.Partial opacifications on bilateral mastoid air cells.Brain MRA:3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate normal ICAs, MCAs and ACAs. Vertebrobasilar system appears to be normal.C-Spine MRIThere are T2 and STIR high signal intensity spinal cord gray matter from skull base to the level of upper thoracic spinal cord. Diagnostic possibilities include acute anterior spinal artery occlusion related spinal cord infarction, extension of brain edema, or less likely demyelinating disease. Spinal cord diffusion weighted image can be attempted to clarify the possibility of spinal cord infarction.Cervical vertebral column shows kyphotic angulation at C56 with focal central protrusion of disc at the level of C45 and broad based disc bulging at the level of C56 abut thecal sac. However, there is no evidence of spinal canal stenosis or neuroforaminal stenosis.Diffuse enhancement of nasopharynx and oropharynx on Gad injection is likely related to endotracheal intubation and nasogastric tube insertion.
1. Multifocal supra and infra tentorial, hemispheric and brain stem acute ischemic infarctions as described above. 2. Cervical spinal cord gray matter lesions, differential diagnosis include acute spinal cord ischemia or extension of brain stem ischemia related edema. Cervical spinal diffusion weighted imaging can be considered for further evaluation.3. Right MCA territorial subacute or early chronic ischemic infarction with petechial hemorrhages.4. No evidence of intracranial arterial stenosis or intracranial arterial aneurysm. 