Diagnosis: Altered mental status, unspecifiedClinical question: AMS; baseline dementia but worsening in last 48 hours There is a focus of diffusion restriction present in the left cerebellar hemisphere it is smaller than 1 cm in size. There is a punctate focus of diffusion restriction along the posterior aspect of the right temporal lobe along the cortex.There are punctate T2 and FLAIR hyperintense subcentimeter sized foci present in the cerebellar hemispheres bilaterally as well as in the brainstem. There is a mild to moderate degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.There are several punctate foci of signal hypointensity in the susceptibility weighted imaging within the pons and the left thalamus as well as in the right parietal subcortical white matter. These are too few in number to represent a specific pattern.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.
1.A couple punctate foci of subacute microinfarction in the left cerebellar hemisphere and in the right cerebellar hemisphere.2.Periventricular and subcortical white matter lesions of a mild to moderate degree and multiple cerebellar and brainstem lesions are nonspecific. At this age they are most likely vascular related. 