History of DM, HTN, and ESRD admitted for kidney transplant yesterday. The patient had an episode of lost of consciousness, hypoxia, hypotension, and no urine output for about 15 minutes and has central sleep apnea. MRI: There is band-like high T2 signal in the pons and bilateral middle cerebellar peduncles. The brain parenchyma otherwise appears unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. There is minimal fluid in the right mastoid air cells. There appears to be swelling and T2 hyperintensity of the right upper lip, which may be post-traumatic.MRA: There is no evidence of significant steno-occlusive lesions or saccular aneurysms.
1. Band-like signal abnormality in the pons and bilateral middle cerebellar peduncles along the expected course of the pontocerebellar fibers may represent an atypical form of posterior reversible encephalopathy syndrome, an unusual form of osmotic demyelination, drug-induced effects, or other toxic metabolic effect.2. No evidence of significant cerebrovascular steno-occlusive lesions.Discussed with Dr. Bodzin at 4:30 PM on 12/31/15.