Reason: Increased seizure frequency and recent history of septic shock and profound hypotension. Evaluate for structural and/or ischemic changes. History: Trisomy 21, seizure disorder, OSA and central apnea S/P Severe septic shock. The ventricles, cortical sulci, and extra-axial spaces are prominent compatible with diffuse parenchymal volume loss which can be seen with Down syndrome and which appears similar in distribution to the 10/16/2009 examination. There are diffusely scattered punctate foci of susceptibility effect in a nonspecific distribution compatible with chronic microhemorrhages. No additional parenchymal signal abnormalities are identified. There is no restricted diffusion to suggest acute infarct. No focal signal rebound is involving the hippocampi. No cortical dysplasias, gray matter heterotopias, or other structural abnormalities are identified to suggest a seizure focus.There is partial opacification of the left mastoid air cells The paranasal sinuses are underpneumatized.
1.Diffuse parenchymal volume loss appearing similar in distribution to the 2009 and which can be seen with Down's syndrome.2.No focal cortical abnormalities.3.Nonspecific, multiple scattered foci of chronic microhemorrhage throughout the brain. 4.Partial opacification of the left mastoid air cells.