Other fatigue [R53.83] / Altered mental status, unspecified [R41.82], Reason for Study: ^Reason: eval remote brain injury History: lethargy, facial droop Brain MRIThere is no evidence of acute ischemic or hemorrhagic lesion on the scan. There is suspicious focal nodular enhancement on the left precentral gyrus (Series1101, image 27/36) but the lesion is not conspicuous on other imaging sequences especially 3D SPGR post contrast images. Therefore, this lesion could represent vascular structure such as cortical vein. There is no other unusual enhancement on this scan.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. The mastoid air cells are clear. Mucosal thickening on ethmoid sinus and left maxillary sinus were seen.Brain MRA3D 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.
1. No evidence of acute ischemic or hemorrhagic lesion on the scan.2. There is a focal nodular enhancing lesion on the left frontal lobe precentral gyrus which likely represent cortical vein as described above. Otherwise no evidence of abnormal enhancement.3. Normal brain MR angiogram.