Diagnosis: Heart transplant status Heart transplant statusClinical question: s/p OHT now w/ delirium and confusionSigns and Symptoms: delirium and confusionComments: With Gadolinium please | The CSF spaces are appropriate for the patient's stated age with no midline shift. There are no foci of diffusion restriction identified. There are small foci of T2 shine through however.On susceptibility imaging there are multiple punctate foci of hypointensity scattered throughout the subcortical white matter of the supratentorial brain as well as in the cerebellar hemispheres. Additionally there is more patchy like gyriform susceptibility effect along the right middle temporal gyrus along its posterior aspect which is associated with loss of volume and T2 and FLAIR signal hyperintensity compatible with encephalomalacia.Foci of encephalomalacia are present in the right middle frontal gyrus and the right middle temporal gyrus. There are T2 and FLAIR hyperintense subcentimeter foci present along the gray matter adjacent to the left postcentral sulcus, and scattered in the left parietal lobe, right parietal lobe and in the frontal lobes.Several punctate foci of the T2 and FLAIR signal hyperintensity are present in the left thalamus as well as the cerebellar hemispheres.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.No abnormal enhancing 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.
1.There are multiple small foci of either encephalomalacia and subcentimeter cortically based lesions which are suspicious for prior foci of infarction in multiple locations. The largest ones are in the right middle temporal gyrus in the right middle frontal gyrus.2.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. They're most likely vascular related.3.Findings suggest prior lacunar infarct involving the left thalamus. Additionally some lacunar infarcts are present in the cerebellar hemispheres.4.There are multiple microhemorrhages scattered in the subcortical white matter which are nonspecific.5.There is no evidence for acute ischemic cerebral infarction at this time.