Delirium and agitation. History of lupus nephritis. On chronic high-dose steroids. Rule out cerebritis or brain infection. The exam was initially ordered with and without contrast but given the lack of IV access, it was changed to without contrast. The examination is also moderately limited by patient motion, which is most pronounced on the susceptibility-weighted imaging despite being repeated. There is no gross intracranial hemorrhage.There is confluent T2/FLAIR hyperintensity in the left frontal periventricular/deep white-matter associated with ex vacuo enlargement of the anterior body/frontal horn of the left lateral ventricle. This is not significant change since the November 2007 CT scan. In addition, there are symmetric T2/FLAIR hyperintense lesions in the frontoparietal white-matter. There is no diffusion restriction. In addition to dilated perivascular spaces, there are small foci of CSF intensity in the basal ganglia regions and in the frontal periventricular white-matter, especially on the left, which probably represent chronic lacunar infarcts. There is no mass-effect or midline shift and there is no extra-axial fluid collection. The ventricles and other CSF-containing spaces are moderately expanded, reflecting underlying brain volume loss. The major intracranial vascular flow voids are grossly preserved. There is no gross orbital abnormality. There is no large, destructive osseous lesion. There is scattered mucosal thickening in the paranasal sinuses.
1.The examination is limited by patient motion and by the lack of intravenous contrast given the lack of intravenous access.2.There is no acute infarct. There is no gross intracranial hemorrhage but the hemorrhage-sensitive sequences are markedly limited by motion. With there is no definite sign of cerebritis, the sensitivity of the examination for detecting leptomeningitis is significantly low given the lack of intravenous contrast.3.Left frontal white-matter lesion with associated volume loss most likely represents gliosis related to remote insult, probably ischemic.4.Mild-to-moderate frontoparietal white-matter abnormality is nonspecific but may represent chronic microvascular ischemia. There are also small chronic lacunar infarcts. 