Clinical question: altered mental status. Signs and symptoms: Altered mental status. Nonenhanced head CT:Examination demonstrate multiple foci of vasogenic edema extensively on the left side and to a lesser degree on the right. This results in effacement of adjacent cortical sulci and mass effect on the left lateral ventricle as well as 7.7-mm rightward midline shift. Within the areas of vasogenic edema there are isodense to mildly high density masses which are highly suspected for multiple metastatic foci. Images through the posterior fossa are unremarkable.Calvarium is intact. Visualized mastoid air cells and middle ear cavities as well as paranasal sinuses are unremarkable. Recommend further follow-up with a dedicated MRI of brain with enhancement.
Multiple bihemispheric foci of vasogenic edema a component disease left greater than right) and suspected internal foci of isodense to slightly high density masses. Findings are highly suspected of metastatic disease. Recommend further follow-up with an MRI exam for confirmation of metastases and/or an infectious process.