Clinical question: Evaluate etiology of alteration of mental status. Signs and symptoms: Alteration of mental status. Nonenhanced brain MRI:No acute intracranial process and in particular no evidence of acute ischemic stroke.Ventricle and to a lesser degree subcortical patchy foci of flair/T2 hyperintensity on the in bilateral hemispheric white matter are nonspecific however considering the patient's stated age likely representing sequela of microvascular chronic ischemic changes of mild degree without hemorrhage.The cerebral cortex and cortical sulci are slightly prominent however without detectable signal abnormality.Bilateral basal ganglia, thalami, pons and cerebellum/vermis demonstrate normal morphology and signal intensity on all MRI sequences.Calvarium, orbits, paranasal sinuses and mastoid air cells demonstrate no abnormalities.
1.No acute intracranial process.2.Findings suggestive of mild chronic nonhemorrhagic small vessel ischemic strokes only in the subcortical and periventricular white matter.3.Unremarkable nonenhanced brain MRI otherwise.