Other convulsions [780.39], Reason for Study: ^Reason: concern for PRES History: altered mental status in the context of high blood pressure There is curvilinear high signal intensity lesion on DWI at the left inferior parietal lobule likely on the left supramarginal gyrus which shows partial diffusion restriction on ADC map and left superior frontal gyrus which shows restricted diffusion indicating acute/subacute ischemic infarction. There is no evidence of hemorrhagic transformation.There are however multifocal susceptibility artifacts without surrounding edema on bilateral hemispheres, basal ganglia, brain stem and especially on the left side midbrain indicating prior hemorrhagic foci and chronic petechial parenchymal hemorrhages. No change since prior scan.On FLAIR imaging, extensive patch high signal intensities on periventricular white matter and centrum semiovale bilaterally indicating advanced nonspecific small vessel ischemic disease. No change since prior scan.The ventricles, sulci and cisterns are prominent which could be related to volume loss. There is no mass, mass effect, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.
1. Acute/subacute ischemic infarctions on the left superior frontal gyrus and left inferior parietal lobule without evidence of hemorrhagic transformation.2. No change of multifocal bihemispheric susceptibility artifacts as well as extensive non specific white matter lesions since prior scan.3. No evidence of abnormal enhancement. No evidence of PRES on this scan.