History of end-stage renal disease status post parathyroidectomy. Past medical history significant for previous cerebrovascular accident now with worsening altered mental status, concern for repeat cerebrovascular accident versus seizure. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is extensive subcortical and deep cerebral white matter T2 hyperintensity bilaterally. There are small areas of encephalomalacia in the bilateral basal ganglia, thalami, and cerebellar hemispheres. There is mild diffuse cerebral volume loss. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is mucosal thickening and fluid in the bilateral sphenoid sinuses. There is a small posterior disc-osteophyte complex at C3-4 that abuts the spinal cord.
1. DIffuse cerebral white matter abnormality bilaterally may represent small vessel ischemic disease and/or toxic-metabolic encephalopathy.2. Chronic lacunar infarcts in the bilateral basal ganglia, thalami, and cerebellar hemispheres, but no acute infarcts. 3. Findings suggestive of acute sphenoid sinusitis.4. A small posterior disc-osteophyte complex at C3-4 abuts the spinal cord.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.