Altered mental status, unspecified [R41.82], Reason for Study: ^Reason: New delerium of unclear etiology. On Tacrolimus. Concern for PRES History: Delerium The bone marrow signal intensity of clivus, upper cervical spine as well as skull show low signal intensity on T1 weighted image.On Gad enhanced scan, the clivus and some portion of C2 and C3 vertebral bodies show enhancement. Constellation of above findings indicate conversion of fatty marrow to red marrow or diffuse infiltrative condition or post bone marrow transplantation status with possibly associated with inflammation or infectious condition of clivus and vertebral bodies. Clinical correlation is recommended.No evidence of acute ischemic or hemorrhagic lesion.Scattered T2/FLAIR high signal intensity lesions on periventricular white matter is nonspecific, could represent small vessel ischemic disease.The ventricles, sulci and cisterns are unremarkable. The midline structures are normal. Normal flow voids are identified in the major intracranial vessels. The mastoid air cells are clear.Mucosal thickenings are seen on the bilateral ethmoid sinuses, sphenoid sinus and bilateral maxillary sinuses are seen.
1. Abnormal bone marrow signal intensity involving clivus, upper cervical spine and skull which indicate conversion of fatty marrow to red marrow, diffuse infiltrative lesions or post bone marrow transplantation status.2. Abnormal enhancement of clivus and upper cervical vertebral bodies indicate possible infectious or inflammatory lesions.3. No evidence of acute ischemic or hemorrhagic lesion. 4. Non specific small vessel ischemic disease. 