Altered mental status, unspecified [R41.82], Reason for Study: ^Reason: evaluation of possible septic emboli seen on previous head ct History: encephalopathy There are multifocal bihemispheric high signal intensity lesions on DWI which most likely represent T2 shine through indicating chronic lesion such as encephalomalacia. However, there are several mildly restricted diffusion lesions especially on bilateral centrum semiovale could represent evolving ischemic infarctions likely late subacute stage. There is a focal susceptibility lesion which does not show restricted diffusion on this scan on the right superior frontal gyrus (series 10, image 26) which may indicate parenchymal petechial hemorrhage or calcification. However, there is evidence of discrete brain parenchymal hemorrhage with surrounding edema indicating acute hemorrhagic lesion.The ventricles, sulci and cisterns are symmetric and unremarkable. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. Mucosal thickenings on bilateral maxillary and sphenoid sinuses.Bilateral mastoid air cells show opacifications.
1. Chronic ischemic lesions on bilateral hemisphere with several evolving late subacute ischemic lesions as described above.2. Focal susceptibility lesion on the right superior frontal gyrus may indicate focal petechial hemorrhage otherwise no remarkable finding.Rec: if clinically suspicious for septic emboli, please consider gadolinium enhanced MRI scan.