Male, 64 years old, with altered mental status, difficulty weaning from vent. A single 5 mm focus of restricted diffusion is seen within the white matter of the right centrum semiovale. No other areas of restricted diffusion are evident.Extensive patchy FLAIR hyperintensity is seen within the periventricular white matter, the basal ganglia and the pons. There is no associated edema or mass effect. No specific abnormalities are seen within the inferior right frontal lobe as suspected on prior CT.No evidence of acute intracranial hemorrhage or any abnormal extra-axial fluid collection is seen. Ventricular size and morphology are normal. The sulci are prominent compatible with parenchymal volume loss. No pathologic parenchymal or extra-axial enhancement is seen.Fluid and mucosal inflammation in the paranasal sinuses is compatible with intubation. An oval enhancing focus is seen within the right parietal bone corresponding to an area of lucency noted on prior CT. No other significant bone marrow abnormalities are detected.
1.A single 5 mm focus of acute ischemia is seen within the right centrum semiovale.2.The background brain demonstrates moderately advanced chronic small vessel ischemic disease.3.No evidence of parenchymal edema, mass effect or pathologic intracranial enhancement is seen.4.A nonspecific enhancing right parietal bone lesion is seen.