Altered mental status, AIDS (CD4 6), evaluate for mass or stroke or signs of CNS infection. Please note lack of contrast limits the evaluation for infection. However, there is no evidence of intracranial mass, abscess or empyema. There are patchy and scattered bilateral cerebral white matter T2/FLAIR hyperintensity which are nonspecific, likely relating to small vessel ischemic changes. There is a small focus of T2/FLAIR signal in the right middle cerebellar peduncle abutting the fourth ventricle, which is not well evaluated without intravenous gadolinium, which is nonspecific and may also be related to prior ischemia. There are small foci of susceptibility in the left frontal lobe as well as along the wall of the left lateral ventricle compatible with chronic microhemorrhages and are nonspecific in distribution. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. There is aerated secretion in the sphenoid sinuses, as well as mucus retention cysts in the bilateral maxillary sinuses. There is trace fluid in the bilateral mastoid air cells. The bone marrow signal is diffusely heterogeneous which is nonspecific.
1. Lack of contrast limits evaluation for intracranial infection. There is however no evidence of mass, abscess, or empyema.2. Scattered nonspecific cerebral T2/FLAIR white matter lesions are nonspecific, but most compatible with mild chronic small vessel ischemic disease. Small focus of T2/FLAIR hyperintensity along the right middle cerebellar peduncle abutting the fourth ventricle may also be related to the same but not well evaluated without contrast and remains nonspecific. If there remains suspicion for intracranial infection, consider post gadolinium sequences if renal function improves or lumbar puncture for further evaluation.3. Diffuse heterogeneity of the bone marrow signal is nonspecific. No frank osseous destructive lesions are seen.