Cystic fibrosis c/b pancreatic exocrine insufficiency, recurrent pseudomonas pneumonia, and chronic hemoptysis s/p multiple bronchial embolizations with ongoing hemoptysis, adrenal insufficiency, and protein malnutrition on PEG tube who presents with AMS and witnessed seizure. There is diffuse gyriform restricted diffusion in the bilateral cerebral hemispheres in a watershed distribution, including the right frontal and parietal lobes and left frontal lobe, with underlying white matter vasogenic edema. There is no evidence of intracranial hemorrhage or mass. The ventricles 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, mastoid air cells, and scalp soft tissues are grossly unremarkable. There is scattered paranasal sinus mucosal thickening and secretions.
1. Gyriform restricted diffusion in the bilateral cerebral hemispheres in a watershed distribution, right more than left, with underlying white matter vasogenic edema. These findings may represent recent watershed infarction or perhaps posterior reversible encephalopathy syndrome with associated infarction or cytotic edema related to seizure activity. 2. Pansinus disease likely related to cystic fibrosis.Discussed with Dr. Kress at 4:45 PM on 6/29/16.