Neck pain (meningismus) and headache. Confusion. Evaluate for signs of infection. The patient could not hold still for the examination. Multiple sequences were repeated.There are multiple rounded and punctate foci of T2 hyperintensity that are non diffusion-restricted and noncontrast-enhancing in the frontoparietal white matter. There is no space-occupying brain lesion. There is no midline shift or mass effect. The ventricles and the other CSF-containing spaces are enlarged, reflecting global volume loss, especially affecting the cerebellum. There is subtle contrast enhancement along the interfolial spaces on the inferior surface of the cerebellum. Similarly, there is subtle scattered increased contrast enhancement within the sulci, especially near the vertex. FLAIR images are degraded by patient motion and therefore corresponding sulcal FLAIR hyperintensity cannot be assessed for. There is no intracranial hemorrhage or brain abscesses. The dural venous sinuses and major intracranial arteries are patent.There is a small left orbital floor fracture with herniation of fat and abnormal contour to the inferior rectus muscle.
1.Subtle supratentorial and infratentorial leptomeningeal contrast enhancement may reflect leptomeningitis in the proper clinical setting. There is no focal collection or brain abscess.2.Generalized volume loss greater than expected for patient's stated age. 3.Frontoparietal white matter T2 hyperintense foci without diffusion restriction or contrast enhancement are nonspecific, with the differential including infectious/inflammatory etiologies, demyelinating disease, or relating to chronic microvascular ischemia advanced for patient's stated age. Please correlate clinically.4.Chronic appearing left orbital floor fracture with herniation of orbital fat.