Clinical question: Encephalopathy? Patient altered status post extubation history of multiple myeloma. This extrahepatic; upward going Babinski; areflexia. Nonenhanced brain MRI:No acute intracranial process and negative diffusion weighted series.Examination demonstrate scattered tiny foci of FLAIR and T2 hyperintensity in the subcortical and periventricular white matter which are nonhemorrhagic and nonspecific. This appearance however in this age group is often result of microvascular ischemic changes. Minimal similar signal changes in the basal ganglia is also noted.The cerebral cortex and cortical sulci as well as ventricular system and CSF spaces are within normal restaging age and maintained midline.The signal void of major intracranial branches are identified. Unremarkable images through the orbits.Bilateral mastoid air cells demonstrate extensive opacification however without detectable opacification of middle ear cavities.Paranasal sinuses remain well pneumatized and only a small retention cyst in the left chamber of the sphenoid sinus is noted.
1.No acute intracranial process.2.Mild chronic small vessel ischemic strokes as detailed and unremarkable exam otherwise.3.Opacification of bilateral mastoid air cells.