67-year-old female ESRD on HD, found down at home, bacteremia, sepsis, in atrial arrhythmia. Overall weakness. Evaluate for cause of acute altered MS. Clinical differential diagnosis includes stroke (septic emboli or thromboembolic), meningoencephalitis. There are multiple patchy areas of restricted diffusion which are mostly concentrated within the watershed regions of the cerebral hemispheres bilaterally with additional scattered foci elsewhere including the cerebellum and right hippocampus. Many of these lesions are associated with susceptibility effect either within the parenchyma or adjacent sulci which suggests blood product. No significant edema or mass effect is noted. The ventricles are normal in size with no midline shift. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.
Multiple patchy areas of restricted diffusion which likely represent small infarcts with many of these lesions located in the watershed regions and many associated with evidence of blood products. Differential includes bland embolic or watershed infarcts, however the presence of such extensive blood product would be unusual outside of a coagulopathy or anticoagulation. than patient is coagulopathic. Therefore, and given the history, septic emboli should also be considered. Findings were discussed with Dr. Krishnamoorthi by phone on 12/21/2015 at 4:15 PM. 