Diagnosis: SomnolenceClinical question: cause of altered mental statusSigns and Symptoms: altered mental status There is left-sided intraventricular blood present and to a lesser degree right-sided intraventricular blood.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. T2 and FLAIR hyperintense lesions are also present in the right thalamus, right external capsule and in the brainstem.Some susceptibility effect is identified along the tract coursing through the right frontal lobe into the right lateral ventricle presumably related to prior ventriculostomy tube which can be identified on recent head CTs and has since been removed.There is a high signal focus present along the caudate tail the subependymal region adjacent to the left lateral ventricle measuring approximately 18 x 4 mm axial dimensions.There are a couple foci of punctate signal loss on susceptibility imaging present. One is located within the left thalamus, one is located in the right frontal lobe subcortical white matter.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. The eyeball lenses are thin.Some retained secretions are present in the nasopharynx status post nasogastric tube placement.
1.There is intraventricular blood present predominantly in the left lateral ventricle. There is associated intraparenchymal blood along the subependymal region along the caudate tail adjacent the body of the left lateral ventricle. Presumably this represents the source of bleeding.2.Lesions in the right thalamus and right external capsule most likely represent lacunar old infarcts3.Periventricular and subcortical white matter changes of a moderate degree are nonspecific. At this age they are most likely vascular related. 