Altered mental status, abnormal signal intensity on pons, bilateral thalami and basal ganglia. Increased T2 signal intensities on brainstem especially midbrain and pons, bilateral thalami and basal ganglia do not show significant interval change since prior exam.There is evidence of circumferential restricted diffusion especially on the pons, but again the pattern and MR signal characteristics have not been changed since prior exam.There is no evidence of acute hemorrhagic lesion.The ventricles, sulci and cisterns are symmetric and unremarkable. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.Above described lesions are again non specific.The restricted diffusion lesion on pons could represent acute ischemic lesion but not typical feature considering not following vascular territory. Bilateral thalami and basal ganglia lesions may indicate metabolic lesions or encephalitis but again non specific. Above findings do not show any significant interval change since prior exam.Gad enhanced MRI can be helpful for differential diagnosis.
Multifocal high signal intensities on FLAIR images including bilateral thalami, basal ganglia, as well as pons which shows circumferential restricted diffusion lesions. No significant interval change since prior exam.These are again non specific findings and not typical for acute ischemic lesion, nor hepatic encephalopathy. Gad enhanced MRI is recommended for further evaluation.