Acute lymphoid leukemia. Altered mental status and right-sided tremor. The study is limited by patient motion. There are patchy areas of FLAIR hyperintensity involving the bilateral subcortical and periventricular white matter. Relatively more prominent of these is seen involving the left posterior frontal centrum semiovale and corona radiata. There are punctate foci of mild restricted diffusion within this area of FLAIR hyperintensity with subtle enhancement. There is also a subtle focus of enhancement in the right cerebellar hemisphere which also shows mild diffusion restriction (better seen on the ADC, then on the limited DWI).The other scattered foci of cerebral white matter abnormality show no diffusion restriction or contrast enhancement and are nonspecific. There is no intracranial mass or mass effect. Ventricles are within normal limits without evidence of hydrocephalus. Mild global parenchymal volume loss is commensurate with age. Bone marrow signal and extracranial soft tissues are unremarkable.
1.Study is limited by patient motion as described above.2.There are punctate foci of mild restricted diffusion in the left frontal lobe and right cerebellum with enhancement. These are favored to represent subacute infarcts or posttreatment-related injury. There are patchy areas of FLAIR hyperintensity in the left frontal centrum semiovale and corona radiata as well as scattered elsewhere in the white matter which may represent posttreatment and/or chronic ischemic change. Given history of systemic infection, it is also possible the foci of FLAIR hyperintensity and foci of enhancement and restricted diffusion are infection-related (cerebritis); however there is no evidence of intracranial abscess, empyema, or abnormal meningeal enhancement to support this differential. Follow-up MRI to evaluate for evolution and CSF evaluation may be considered as clinically indicated.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.