54-year-old male with altered mental status. Again seen are patchy areas of low attenuation in the subcortical and periventricular white matter, which are nonspecific and have progressed since recent MRI. Please refer to the MRI report from 5/22/2009 for further detail. There may be a new focus of low attenuation in the right brainstem (image 8/36, series 2), which may be further evaluated with MRI if clinically indicated.There is no evidence of intracranial hemorrhage or abnormal extra-axial fluid collections. The ventricles are midline, with normal volume and morphology. There is no midline shift or mass effect.The calvaria and other osseous structures are intact, with no fracture. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.
1. New hypoattenuating focus in the right midbrain, which may be further evaluated by MRI if clinically indicated.2. Progression of extensive white matter abnormality, with differential including demyelinating disease versus underlying metabolic abnormality. 