Clinical question: Patient presents with AMS, global dysfunction without focal deficits. History of renal dysfunction and cannot use IV contrast. Evaluate for potential etiology of AMS. Signs and symptoms: As above. Nonenhanced brain MRI:Examination is severely limited and incomplete due to extensive motion artifacts, repeat exam is recommended.Negative diffusion weighted images.Ventricular system remains within normal size and maintained midline.There is slight prominence of cortical sulci.There are subtle periventricular and subcortical foci of flair/T2 hyperintensity which are nonspecific all are in proper clinical setting could represent chronic changes of microvascular ischemic process.There is no detectable intracranial hemorrhage, mass effect or midline shift. No convincing evidence of a mass on this nonenhanced exam. Calvarium and orbits are unremarkable.Mastoid air cells, middle ear cavities and all paranasal sinuses demonstrate normal pneumatization signal pattern.
1.Suboptimal and limited exam due to extensive motion artifact.2.Within this limitation no acute intracranial process is detected.3.Minute subcortical and periventricular foci of flair hyperintensity is a nonspecific finding however in proper clinical setting could represent chronic small vessel ischemic strokes.