Altered mental status [780.97], Reason for Study: ^Reason: evaluate for etiology of mental status changes, f/u hypodense regions noted on CT, ?PRESS History: mental status change, hypertension, hypodense regions on CT Motion artifacts degraded examination quality.There are ill defined high signal intensity lesions on bilateral occipital lobes subcortical white matter, bilateral frontoparietal lobes especially vertex area and bilateral thalami on FLAIR images without showing evidence of hemorrhages. These findings are suggestive of PRESS.On ADC maps, there are curvilinear low signal intensity lesions on the right middle temporal gyrus without showing high signal intensity on diffusion weighted images. These lesions do not show high signal intensity on neither T2 nor FLAIR images. These signal characteristics may indicate possible hyper acute ischemic infarction or artifacts. There is no evidence of acute hemorrhagic lesion.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia.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.3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate multifocal luminal narrowings on MIP reconstruction. However, these lesions could all be artifactual due to motion artifacts. 3D MRA neck non contrast enhanced images with maximum intensity projections of the cervical vasculature demonstrate normal flow enhancement in a normal aortic arch origin of the right brachiocephalic, left common carotid, and left subclavian arteries. There is normal flow enhancement through the bilateral common carotid, carotid bifurcations, internal/external carotid, and vertebral arteries.
1. Patchy high signal intensities on bilateral occipital lobes, thalami and fronto-parietal lobes vertex area indicate possible PRESS.2. Right temporal lobe lesion which showed restricted diffusion on ADC map could represent an artifact or hyper acute ischemic lesion as described above.3. Motion artifacts degraded image quality. 