44-year-old female status post PEA arrest, EEG with diffuse anoxic encephalopathy. Evaluate for anoxic encephalopathy; patient can't get MRI secondary to obesity. The CSF spaces and sulci appear more prominent than in prior examinations suggesting decreasing diffuse cerebral edema. For instance, the anterior horn of the left lateral ventricle measures 7-mm (series 3 image 17/32), previously measuring 4-mm in the 1/4/2012 exam (series 4 image 12/30) and 3-mm in 12/31/2011 exam (series 3 image 17/31). In the prior 7/29/2008 MRI brain, presumably at the patient's baseline, it measured 6 mm in diameter (series 4 image 9/21).There are scattered subtle parenchymal hypodensities that may be artifactual in etiology, but true pathological change is difficult to exclude.There is no evidence of intracranial hemorrhage or mass. There is no midline shift, or basal cistern effacement.The calvaria and skull base are radiographically normal. There is increased opacification of the bilateral sphenoid sinuses, greater on the right. The visualized paranasal sinuses are clear. There is interval increase in bilateral mastoid air cell opacification.There is a nasoenteric tube and endotracheal tube.
1. Increasing CSF spaces and sulci suggest decreasing diffuse cerebral edema.2. Increasing sphenoid sinus and mastoid air cells opacification, likely related to intubation status.3. Scattered subtle parenchymal hypodensities may be artifactual in etiology, but subtle encephalopathic changes cannot be completely excluded. Followup can be considered.