Concern for meningitis and brain metastases: fever, headache, altered mental status; note severely hypertensive since admission. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are scattered areas of high T2 signal in the cerebral and pontine white matter. There is no definite abnormal intracranial enhancement, although the post-contrast images are particularly degraded by patient motion. 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.
A punctate focus of apparent restricted diffusion in the right occipital lobe may represent a recent infarct superimposed upon a background of chronic small vessel ischemic disease. Otherwise, no evidence of intracranial metastases or abscess, although the images are generally degraded by patient motion.