 Cortical/subcortical foci of T2 hyperintensity are present in bilateral cerebral hemispheres, the pons, the right dorsal brainstem, and bilateral cerebellum. There is some associated restricted diffusion within cortical watershed areas, in conjunction with with these aforementioned T2 hyperintense abnormalities.The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. There are no masses, mass effect or midline shift. The pituitary gland is normal in size. There is no evidence for intracranial hemorrhage. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. Scattered fluid can be found throughout the paranasal sinuses and mastoid air cells, likely secondary to the patient's intubated status. There is no abnormal enhancement within the brain.
The constellation of MRI abnormalities found within both the supratentorial and infratentorial brain are most consistent with posterior reversible encephalopathy syndrome (PRES). Differential considerations include postictal seizure foci with ischemia considered less likely.