Diagnosis: Altered mental statusClinical question: rule out new structural lesion, new strokeSigns and Symptoms: pt w/ ho vascular dementia with prior strokes in multiple vascular territories, admitted for AMS,Comments: Pt has severe vascular dementia. Please assess whether pt could be scanned without sedation. If not, study may be cancelled. | The lateral ventricles remain large relative to sulci.There is a mild to moderate degree of periventricular and subcortical confluent hyperintense white matter lesions present identified on the FLAIR and T2 images. This was also present on the prior exam.There are small punctate lesions in the cerebellar hemispheres present which are bright on T2 and low signal on T1 and FLAIR which are unchanged since the prior exam. A small lesion in the left thalamus is bright on T2 and FLAIR sequences and also unchanged since the prior exam.There is encephalomalacia along the left superior frontal gyrus and the anterior aspect of the left cingulate gyrus where there was diffusion restriction on the prior exam. There is associated susceptibility effect as well.No foci of diffusion restriction are appreciated.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.There is some narrowing of the spinal canal at C2-3.
1.No evidence for acute ischemic cerebral infarction.2.No evidence for intracranial mass lesion.3.Encephalomalacia along the left superior frontal gyrus and left cingulate gyrus anteriorly is likely due to prior cerebral infarction.4.Periventricular and subcortical white matter signal changes are nonspecific. At this age they are most likely vascular related though they could be related to a neurodegenerative process such as nonspecific leukoencephalopathy of aging. 5.Old lacunar infarcts are present in the cerebellar hemispheres and left thalamus.