Diagnosis: Injury, unspecifiedClinical question: c-spine clearance, found down unresponsive at home.Signs and Symptoms: c-spine clearance, found down unresponsive at home.Clinical question: evaluate brain mass seen on HCT 10/22.Signs and Symptoms: eval for brain mass seen on CT 10/22. MRI brain:There is a 17x20 mm axial dimension ring enhancing mass present in the left parietal lobe subcortical white matter associated with a small focus of susceptibility effect and diffusion restriction. There is marked amount of vasogenic edema. There is mass effect associated with the vasogenic edema with compression of the right lateral ventricle and sulcal effacement There is a 9mm focus of contrast enhancement associated with susceptibility effect located in the posterior aspect of the left insular cortex.The ventricles are enlarged. There are periventricular confluent and patchy white matter T2 and FLAIR signal hyperintense lesions of a mild to moderate degree. There are patchy signal T2/FLAIR signal hyperintense foci in the brainstem.Normal vascular flow voids are present in the distal carotid arteries, the left vertebral artery, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus. The right vertebral artery flow void is not readily appreciated.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.MRI cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. There is multilevel disk dessication present.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal. There is a disk bulge and ligamentum flavum hypertrophy present at this level. There is mild spinal stenosis at this level. There are bilateral uncovertebral osteophytes at this level mildly narrowing the neural foramina at this level.At C4-5 there is no significant compromise to the spinal canal or neural foramina. There is a disk bulge and ligamentum flavum hypertrophy present at this level. There are bilateral uncovertebral osteophytes at this level minimally narrowing the neural foramina at this level.At C5-6 there is no significant compromise to the spinal canal or neural foramina. There is a disk bulge present at this level. There are small bilateral uncovertebral osteophytes at this level minimally narrowing the neural foramina at this level.At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The left vertebral artery flow void appears to be intact. The right vertebral artery appears smaller than the left. The right vertebral artery flow void is not readily appreciated.
1.There is a left parietal lobe ring enhancing mass present associated with minor hemorrhage and diffusion restriction. Differential considerations include infection (abscess) as well as neoplasia (metastasis or possibly primary brain tumor).2.There is a hemorrhagic lesion along the posterior aspect of the left insular cortex.3.Marked ventriculomegaly. The possibility of normal pressure hydrocephalus cannot be excluded. Alternatively this could represent communicating hydrocephalus. 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.Lesions in the brainstem are most likely vascular related.6.Findings raise the question of possible compromise (i.e. occlusive disease) to the right vertebral artery which is the non-dominant vertebral artery.7.There are degenerative changes present in the cervical spine without significant compromise to the spinal canal or exiting nerve roots. There is mild spinal stenosis at C3-4.