Unspecified psychosis Unspecified psychosisClinical question: strokeSigns and Symptoms: confusionHistory of obesity, anemia, headache, bacteremia, fall, gastroesophageal reflux, fever, anxiety, sleep disorder, depression, constipation, hemodialysis, Benign lymphogranulomatosis of Schaumann, Diabetes mellitus type 2, noninsulin dependent, H/o kidney transplant, Disseminated lupus erythematosus The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear to the extent of visualization possible on this limited exam. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.Examination is degraded by patient motion.
1.Examination is limited due to patient's inability to cooperate and motion artifact. As a result any small or subtle lesions would be easily overlooked. If there is persistent concern an examination the patient is able to cooperate or with the help of anesthesia may be helpful.2.There is no evidence for acute cerebral infarction.3.Periventricular and subcortical white matter signal changes of a mild degree are present which are nonspecific. They could be vascular related (most likely given the PMH), related to demyelination, trauma, vasculitis, sarcoid. They are nonspecific. 