Worsening altered mental status unclear etiology. History of CLL treated with SCT with lymphadenopathy. There are multiple enlarged bilateral upper neck lymph nodes with low diffusivity, including within the parotid glands and retropharyngeal space. There is diffuse patchy cerebral white mater T2 hyperintensity bilaterally. There is a subcentimeter prominent left basal ganglia prominent perivascular space. There is no evidence of gross intracranial hemorrhage, mass, or acute infarct. The ventricles, sulci, and basal cisterns are normal in size and configuration. 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.
1. Multiple enlarged bilateral upper neck lymph nodes may represent a manifestation of leukemia or post-transplant lymphoproliferative disorder, for example. 2. Diffuse patchy cerebral white mater T2 hyperintensity bilaterally is nonspecific, but may represent small vessel ischemic disease and/or treatment effects. 3. No gross evidence of acute intracranial hemorrhage, mass, or acute infarct.