44-year-old female with altered mental status. Evaluate for intracranial abnormalities or interval change. There are multiple oval-shaped focal T2-hyperintense, T1-hypointense lesion in the cerebral white-matter that are somewhat perpendicularly oriented relative to the long axis of the lateral ventricles. There is multifocal punctate susceptibility effect in the cerebrum and cerebellum without associated edema, may reflect hemosiderin staining. These microbleeds may be related to end-stage renal disease-associated microangiopathy. Otherwise, there is no acute intracranial hemorrhage or acute infarct. Without contrast, meningitis cannot be evaluated but there is no empyema, parenchymal abscess and no obvious findings of cerebritis. There is no mass-effect, midline shift or brain herniation. The ventricles, sulci and basal cisterns are mildly to moderately enlarged, reflecting underlying global brain volume loss. The major intracranial vascular flow voids are preserved.There are retention cysts in the maxillary sinuses. There has been bilateral eye lens placement. There is no gross destructive skull lesion or gross scalp soft tissue abnormality.
No appreciable interval change compared to the MRI brain from 5/30/2016. The multifocal cerebral white-matter lesion remain nonspecific with differentials including demyelinating disease or prior ischemia or inflammation. 