 Brain MRI:There is diffuse supratentorial cortical restricted diffusion with matching ADC hypointensity, somewhat sparing the bilateral perirolandic regions. Smaller, more punctate, yet similar appearing foci can be found involving the basal ganglia and thalami. Posterior fossa structures are spared. The cortically based abnormality is associated with T2 hyperintensity and gyral thickening. Within the bifrontal and bilateral parieto-occipital regions of cortical restricted diffusion, abnormality within the subcortical white matter demonstrates decreased diffusion intensity correlating with increased ADC signal as well as T2 hyperintensity.The ventricles are small which may reflect normal anatomic variation, however this could also reflect compression from global swelling. The cerebellar tonsils are in normal position. There are no masses. The pituitary gland is normal in size. There is no evidence for intracranial hemorrhage. There are no extraaxial fluid collections or subdural hematomas. Fluid within the nasopharynx mastoid air cells and middle ear cavities are most likely secondary to the patient's intubated status.Neck MRA:Antegrade flow is noted within the vertebral artery and carotid artery systems without occlusion or hemodynamically significant stenosis. Limited evaluation of the circle of Willis also demonstrates maintained flow without occlusion or hemodynamically significant stenosis.Neck MRI:Nasopharynx, oropharynx, and hypopharynx are unremarkable without mass lesion. Parotid and submandibular glands are normal in appearance without mass lesion. There are no thyroid masses. There is no clinically significant lymphadenopathy. The airway is patent. The right lung apex appears nonaerated, and correlation with x-ray or CT is recommended.
1.There is diffuse supratentorial cortical restricted diffusion with matching ADC hypointensity, somewhat sparing the bilateral perirolandic regions. Smaller, more punctate, yet similar appearing foci can be found involving the basal ganglia and thalami. These findings are consistent with cytotoxic edema of acute or subacute ischemia. Within the bifrontal and bilateral parieto-occipital regions of cortical restricted diffusion, abnormality within the subcortical white matter demonstrates decreased diffusion intensity correlating with increased ADC signal as well as T2 hyperintensity which represent underlying vasogenic edema. This pattern of cytotoxic edema associated with vasogenic edema has been reported as a biphasic edema pattern which can be found in the evolution of acute ischemia. However, an underlying process such as cerebritis remains a consideration with this edema pattern.2.Negative MRA of the neck.3.Negative MRI of the neck.