Altered mental status. Past medical history of ESRD, HTN, anemia of CKD presenting as an OSH transfer for altered mental status and continued MSSA bacteremia. There are numerous punctate foci of restricted diffusion and high T2 signal within multiple cerebral and cerebellar bilaterally, mainly involving watershed zones. There is a small amount of susceptibility effect in the left occipital lobe. There is no evidence of intracranial mass. There is mild diffuse cerebral volume loss. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. There are bilateral tympanomastoid effusions.
1. Numerous punctate foci of cerebral and cerebellar acute ischemia bilaterally, mainly involving watershed zones with possible petechial hemorrhage in the left occipital lobe. Differential considerations include hypotensive infarction or perhaps septic emboli. Assessment is otherwise limited without intravenous contrast, acknowledging the renal failure as a contraindication.2. Nonspecific bilateral tympanomastoid effusions.