Diagnosis: Altered mental status, unspecifiedClinical question: eval etiology of bleed/lesionSigns and Symptoms: confusion MRI of the brainNo diffusion weighted abnormalities are appreciated.There is a 22 x 20 mm sagittal dimension and 15 x 20 mm coronal dimension mass centered at the anterior aspect of the third ventricle which has intermediate signal on T1 and low signal on T2 and associated susceptibility effect. There is adjacent T2 and FLAIR signal hyperintensity along the dependent surface of the third ventricle. Temporal horns of the lateral ventricles are mildly dilated. There is minimal incomplete peripheral enhancement associated with this. The optic chiasm and infundibulum are mildly displaced inferiorlyThere is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.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. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is approximately 70% stenosis of the proximal left middle cerebral artery at the mid M1 segment. There is extracranial origin of the right posterior inferior cerebellar artery. The right vertebral artery is smaller than the left vertebral artery. The left posterior communicating artery is medium-sized whereas the right is very small. Anterior communicating artery is small to medium sized
1.There is 70% stenosis present at the proximal left middle cerebral artery.2.There is a hemorrhagic lesion present at the anterior aspect of the third ventricle associated with a very mild enlargement of the lateral ventricles. The possibility that this represents a neoplasm cannot be excluded. Other considerations include a colloid cyst. 3.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related. 