Septic shock, ARDS, persistent altered mental status slight xanthochromia on lumbar puncture. There is a focal restricted diffusion on the left occipital lobe subcortical white matter indicating ischemic stroke.On gradient echo images, the lesion was associated with focal signal void which may suggest possibility of hemorrhagic conversion. However, precise evaluation of signal intensities on the left posterior temporal and occipital lobe area is not possible due to motion artifacts. Therefore, the diagnosis of possible hemorrhagic conversion the left occipital lobe may need to be followed to confirm the diagnosis.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage. The midline structures and cranial-cervical junction are normal. Left frontal and bilateral ethmoid sinus show fluid collections and mucosal thickenings. Bilateral mastoid air cells show fluid collections. The MRA shows significant motion artifacts which prevents precise evaluation.3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate no evidence of major arterial occlusion or significant luminal stenosis. Vertebrobasilar system appears to be normal. There is no evidence of intracranial arterial aneurysm.
1. Significant motion artifacts degraded image quality.2. Focal restricted diffusion lesion on the left occipital lobe. Suspicious hemorrhagic transformation of the lesion but cannot confirm due to artifacts.3. No definitive evidence of intracranial arterial aneurysm, no significant (more than 50%) arterial luminal stenosis on MRA. 