63 years, Female, new HIV diagnosis, stage IV rectal CA. Evaluate for tumor or infection. Sepsis, altered mental status. Global parenchymal volume loss is noted which is advanced for patient's age. Diffusion-weighted sequences are motion degraded limiting evaluation for acute infarct; however, no obvious acute infarct is evident. Tiny chronic lacunar infarct in the right thalamus is noted. No intracranial mass or mass effect. No extra-axial collections. No hydrocephalus. Several foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with mild chronic small vessel ischemic changes. Trace mucosal thickening is present in the paranasal sinuses, which are otherwise clear. There is mild nonspecific opacification of the bilateral mastoid air cells. Diffuse low T1 marrow signal is noted which is nonspecific and can be seen in conditions such as chronic anemias. No destructive osseous lesions are evident. Extracranial soft tissues are unremarkable.
Limited sequences obtained as patient could not tolerate the full study. No intracranial mass, mass effect, or evidence of edema. No findings to suggest intracranial abscess or empyema. Please note lack of contrast limits evaluation for small metastatic lesions as well as infection, and lumbar puncture should be considered if there is significant suspicion for meningitis.