Diagnosis: Transient alteration of awarenessClinical question: evaluate for brain metsSigns and Symptoms: altered mental status The CSF spaces are appropriate for the patient's stated age with no midline shift. No focus of diffusion restriction is identified in the brain parenchyma.There is a mild to moderate degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. There as several punctate T2 and FLAIR hyperintense brainstem lesions present.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 demonstrate some mucosal thickening. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.
1.Periventricular and subcortical white matter changes of a mild to moderate degree are nonspecific. At this age they are most likely vascular related. To a lesser degree there are similar appearing brainstem lesions present also most likely vascular related.2.No intracranial mass lesion is identified.