Anoxic brain injury: comatose. Drug overdose with UTOX positive for cocaine, opioids, and THC. There is extensive diffuse white matter restricted diffusion and T2 hyperintensity in the cerebral hemispheres bilaterally. The brainstem and cerebellum appear unremarkable. The lateral ventricles are asymmetric, in which the right lateral ventricle is smaller than the left. There is no midline shift or herniation. There is no evidence of intracranial hemorrhage or mass. The major cerebral flow voids are intact. The orbits are grossly unremarkable. There is diffuse paranasal sinus mucosal thickening and retention cyst formation. There is also a small amount of mucosal thickening and fluid in the mastoid air cells bilaterally. The patient is intubated. There is a punctate T2 hyperintense focus in the skin of the right temporal region, which may represent a cyst.
Extensive bilateral cerebral white matter abnormality is compatible with acute drug-induced leukoencephalopathy.