Assess for intracranial pathology, ischemic causes of dementia: altered mental status. There is extensive, mainly confluent, T2 hyperintensity in the cerebral, brainstem, and cerebellar white matter. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.
Extensive cerebral, brainstem, and cerebellar white matter disease is nonspecific, but may represent hypertensive encephalopathy or sequelae of a prior toxic-metabolic process, for example. Otherwise, no evidence of acute intracranial hemorrhage, mass, or acute infarct.