Obtunded, unexplained. Evaluate for infection or inflammation causing severely altered mental status. There is no evidence of acute intracranial hemorrhage, mass, or acute infarct. There is unchanged encephalomalacia involving most of the the right parietal lobe with adjacent FLAIR hyperintensity/gliosis extending into the right frontal and occipital lobes. Global parenchymal volume loss is again seen with prominence of the ventricles and sulci commensurate with patient's advanced age. There is no edema or mass effect. There is no midline shift. The basal cisterns are patent. There are patchy areas of T2/Flair signal abnormalities in the subcortical and the periventricular white matter, which are nonspecific, but most consistent with chronic small vessel ischemic changes. No abnormal parenchymal or meningeal enhancement.Mucosal thickening involving the left maxillary sinus and to a lesser degree right posterior ethmoid and left frontal sinuses is unchanged. Opacification of the left greater than right mastoid air cells is also unchanged. Bone marrow signal and remainder of the extracranial soft tissues are unremarkable.
1.No evidence of acute infarct, hemorrhage, intracranial mass, or mass effect. No abnormal enhancement. No MRI findings to suggest intracranial infection or inflammation; if there is high suspicion for meningitis, consider lumbar puncture for further evaluation.2.Extensive encephalomalacia involving the right parietal lobe, as seen previously, and likely related to prior infarct. 