Diagnosis: Syncope and collapseClinical question: r/o CVA vs seizureSigns and Symptoms: loss of consciousness, hx seizure disorderComments: Please do epilepsy protocol with thin hippocampal cuts. | Patient has Synchromed 2 intrathecal pain pump. Medtronic states the pump is conditional up to 3 Tesla. | Patient has history of carotid disease s/p bilateral carotid stents. | Patient has history of cervical spine disease s/p titanium hardware to c spine. | Creatinine is elevated but at his baseline level. The CSF spaces are appropriate for the patient's stated age with no midline shift. On diffusion-weighted imaging there are several punctate foci of signal hyperintensity representing diffusion restriction by ADC maps located within the cerebellar hemispheres. Two involve the right cerebellar hemisphere and the other involves the medial aspect of the left cerebellar hemisphere.No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.There is a moderate degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. Punctate T2 FLAIR and T2 foci are present in the brainstem, cerebral hemispheres and thalami as well as external capsules and of the right internal capsule..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. The eyeball lenses are thin.
1.Findings suggest that there are mild acute microinfarcts present within the cerebellar hemispheres.2.Periventricular and subcortical white matter changes of a moderate degree are nonspecific. At this age they are most likely vascular related. 3.Multiple (mild degree) punctate lesions in the brainstem, cerebellar hemispheres, thalami, external capsules and right internal capsule are most likely vascular related at this age.4.Images are mildly degraded T2 motion artifact which may obscure more subtle abnormalities.