Clinical question: Concern for encephalitis. Signs and symptoms: AMS, unclear etiology. Nonenhanced brain MRI:Examination is severely compromised due to extensive motion artifact secondary to patient's status. Multip MRI sequences were repeated without significant improvement.Diffusion-weighted images are grossly unremarkable.Examination demonstrates patchy confluent foci of periventricular and minimally subcortical Flair/T2 hyperintensity in bilateral cerebral hemispheres which are nonspecific however considering patient's stated age of 74 likely representing chronic changes of microvascular ischemic disease. There is subtle enlargement (ex vacuo) of ventricular system without deviation of midline.No detectable signal abnormality of cerebral cortex, mildly prominent cortical sulci within normal for stated age and unremarkable CSF spaces. The signal void of major intracranial arterial branches are identified. No gross abnormality of calvarium, soft tissues of the scalp, orbits, paranasal sinuses and mastoid air cells.
1.Severely limited exam due to extensive motion artifact.2.No convincing evidence of an acute intracranial process, edema, bleed, mass effect or midline shift.3.Findings of chronic small vessel ischemic strokes of moderate degree.