Clinical question: 7-year-old female with altered mental status, CSF with evidence ? Bacterial meningitis, this AM less somnolent, now dominant word finding difficulty, evaluate for lesion. Signs and symptoms: Altered mental status, word finding difficulties. Pre-and post-enhanced brain MRI:Negative diffusion weighted series.Examination demonstrates small patchy foci of flair hyperintensity only in the periventricular and subcortical white matter of bilateral cerebral hemispheres (slightly more pronounced on the left) and pons. Although the findings are nonspecific considering patient's stated age of 70 most likely representing chronic microvascular ischemic strokes. The signal intensity and overall morphology the brain is otherwise within normal for age.There is no detectable abnormal enhancement the brain parenchyma, leptomeninges or the calvarium.Unremarkable images through the orbits and including axial fat sat post contrast series.
1.Negative diffusion weighted images for acute ischemic stroke.2.Findings of chronic nonhemorrhagic small vessel ischemic strokes only in the periventricular and subcortical white matter and pons.3.Negative pre-and post-enhanced brain MRI otherwise.