Altered mental status, unspecified [R41.82], Reason for Study: ^Reason: assess for evidence of stroke History: acute stroke code called for slurred speech and possible facial droop, await CT read, however neuro thinks negative CT, recommended MRI Brain MRIDiffuse low signal intensity on clivus and upper cervical spine on T1 images indicate diffuse infiltrative process which could be related to the history of AML involvement.Multiple scattered T2/FLAIR high signal intensity lesions on periventricular white matter indicate non specific small vessel ischemic disease.There is a susceptibility lesion on right external capsule indicate either parenchymal calcification or chronic petechial hemorrhage.Prominent bilateral basal ganglia, red nucleus and substantia nigra on gradient echo images are seen which is non specific.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The mastoid air cells are clear.Mucosal thickening of ethmoid and sphenoid sinuses are seen.Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate normal ICAs, MCAs and ACAs. Vertebrobasilar system appears to be normal. No aneurysm. No significant luminal stenosis.Neck MRA3D MRA neck post-gadolinium images with maximum intensity projections of the cervical vasculature demonstrate normal flow enhancement in a normal aortic arch origin of the right brachiocephalic, left common carotid, and left subclavian arteries. The vertebral artery origins are normal. There is normal flow enhancement through the bilateral common carotid, carotid bifurcations, internal/external carotid, and vertebral arteries.
1. Diffuse infiltrative lesions involving clivus and upper cervical spine, likely related to the patient's history of AML.2. Non specific small vessel ischemic disease.No acute ischemic or hemorrhagic lesion.3. Normal brain MRA and neck MRA. 