Altered mental status; agitation. Also dysphagia and abnormal gait prior to admission. Rule out brain infarct. There is no diffusion restriction to indicate recent infarct. There are multiple tiny CSF intensity foci with T2 FLAIR rim involving the basal ganglia reflecting chronic lacunar infarcts. There is also mild prominence of the perivesical spaces. There is extensive confluent and patchy bilateral cerebral hemispheric white-matter T2 FLAIR hyperintensity along with similar finding in the pons which is nonspecific but most compatible with chronic small vessel ischemic disease. There are foci of susceptibility artifact underlying the posterior right frontal craniotomy flap near the vertex in addition to focal mild dural thickening and underlying minimal encephalomalacia. Otherwise, there is no intracranial hemorrhage. There is no midline shift or brain herniation. The ventricles along with the other CSF-containing spaces are enlarged, reflecting moderate global brain volume loss. Though ventricular enlargement is more pronounced than sulcal enlargement, this is still most probably related to brain volume loss. The flow voids of the major intracranial vessels are preserved, reflecting gross patency. Following contrast injection, there is no abnormal brain or leptomeningeal contrast enhancement. Contrast enhancement in the mildly thickened right frontoparietal dura underlying the craniotomy flap near the vertex is probably postoperative in nature. Asymmetric contrast enhancement in the pterygoid muscles is probably related to asymmetry of the pterygoid venous plexus.There is partial opacification of the bilateral mastoid air cells, partial opacification of the paranasal sinuses, and fluid in the nasopharynx. These findings are likely, at least in part, related to presence of endotracheal tube.
1.Moderate to severe chronic small vessel ischemic disease. No evidence of acute infarct.2.Prior right frontal craniotomy.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.