Reason: r/o acute ischemia History: word finding difficulties Exam is limited by motion artifact. There is effacement of the right central sulcus with nonsuppression of the CSF on FLAIR sequence. There is no evidence of underlying subarachnoid blood on susceptibility-weighted sequence or on earlier CT. There is also FLAIR hyperintensity involving the right frontal cortex. There appears to small left frontal convexity subdural effusion with T2 and FLAIR hyperintensity without mass effect. Nonspecific scattered periventricular and subcortical white matter FLAIR hyperintensity, which may represent chronic small vessel ischemic disease.  No abnormal diffusion restriction. No acute intracranial hemorrhage is identified. No evidence of intracranial mass, mass effect, or midline shift. The ventricles, sulci, and cisterns are age appropriate in size without evidence of hydrocephalus. Gray-white matter differentiation is preserved. The imaged paranasal sinuses and mastoid air cells are clear. The imaged orbits are intact. The osseous structures are unremarkable.
1. No evidence of acute infarct or intracranial mass effect.2. Nonspecific asymmetric effacement of the right central sulcus with nonsuppression of CSF on FLAIR sequence. Findings raise suspicion for an underlying leptomeningeal process such as infection. FLAIR hyperintensity involving the right frontal cortex, which is also nonspecific but can be seen with cerebritis. There is also a small left frontal subdural effusion which may be unrelated and without associated mass effect. If post gadolinium sequences cannot be obtained, consider lumbar puncture for further evaluation if clinically indicated.Findings discussed with Dr. Eisha Wali at the time of dictation.