Diagnosis: Altered mental status, unspecifiedClinical question: seizure etiologySigns and Symptoms: seizures There are multiple foci of the diffusion restriction scattered throughout the brain including both hemispheres of the brain and the posterior fossa. One in the right cerebellar hemisphere measures 31 x 30 mm. One in the left cerebellar hemisphere measures 19 x 22 mm axial dimensions One at the anterior tip of the left temporal lobe measures 30 x 30 mm. A more patchy focus in the posterior aspect of the left temporal lobe extending to the adjacent occipital lobe measures 44 x 20 mm. One in the left middle frontal gyrus measures 34 x 20 mm. One in the left paracentral lobule measures 30 x 13 mm. Small patchy foci of diffusion restriction are present in the occipital poles. A number of punctate lesions are scattered throughout the brain basal ganglia, left cerebral peduncle and pons.There is redemonstration of a foci of encephalomalacia in the left temporal lobe and the left precuneus.There are punctate foci of susceptibility effect present in the brainstem and basal ganglia with patchy foci of susceptibility effect in foci of the encephalomalacia and acute infarction.There is a mild degree of periventricular and subcortical confluent hyperintense white matter lesions present identified on the FLAIR and T2 images. Additional patchy areas of FLAIR and T2 signal hyperintensity are present in the basal ganglia, internal capsules, brainstem and cerebellar hemispheres. The large degree these were present on the 3/16/2015 exam.Postcontrast imaging demonstrates some gyral type contrast enhancement along the left middle frontal gyrus and some smaller foci of enhancement in the basal ganglia.The visualized portions of the paranasal sinuses demonstrate mucosal thickening and partial opacification status post intubation.. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.
1.There are multiple foci of the subacute infarction scattered in both hemispheres of the brain and the cerebellum is detailed above. Some of these represent lacunar infarcts and others are larger. Some of these are associated with the petechial blood. Some associated contrast enhancement may represent a reaction of the blood brain barrier to subacute infarction.2.There is redemonstration of multiple foci of encephalomalacia predominantly involving the left temporal lobe and left parietal lobe. Smaller foci of encephalomalacia are present elsewhere.3.There is redemonstration of a periventricular and subcortical white matter lesions which are suspected to be vascular related but are nonspecific.4.Multiple non-diffusion restricting lesions in the brainstem likely represent older lacunar infarcts5.Multiple microhemorrhages are present in a pattern suggestive of microhemorrhages related to hypertension