Head and neck cancer with acute altered mental status. Evaluate for etiology of the altered mental status. There are post-surgical findings partially visualized related to interval resection of a left parotid mass. There is redemonstration of an 8 mm lesion in the left inferior frontal gyrus with intrinsic T1 shortening, complete hypointense T2 rim and associated blooming susceptibility artifact. There is no associated developmental venous anomaly. There are multiple other scattered punctate foci of susceptibility artifact within the supra- and infratentorial compartments, consistent with hemosiderin deposition from chronic microhemorrhages.The ventricles and sulci are prominent, consistent with mild age-related volume loss. The basal cisterns remain patent. There is no midline shift or mass effect. There are scattered punctate foci and confluent areas of abnormal T2/FLAIR hyperintensity within the periventricular and subcortical white matter, which is nonspecific, but most likely represent minimal small vessel ischemic changes. There is an area of abnormal T2/FLAIR hyperintensity in the left temporal lobe, which may represent gliosis/encephalomalacia. There is no acute infarct. No extra-axial fluid collection is identified. Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. There is minimal mucosal thickening of the right maxillary sinus and mild mucosal thickening of the left maxillary sinus. Fluid is incidentally noted in the right C1-C2 joint, presumably degenerative in nature.
1. Partially visualized post-surgical findings related to resection of a mass in the posterior left parotid space.2. No significant interval change in an 8 mm T1 hyperintense lesion with blooming artifact in the left inferior frontal gyrus, most likely representing a cavernoma. No other evidence of abnormal intracranial enhancement to suggest intracranial metastases.