Shock of unknown etiology, persistent altered mental status, and history of synthetic marijuana use. There is a mildly expansile patchy focus of high T2 signal and restricted diffusion within the midline of the splenium of the corpus callosum. There are also bilateral symmetric foci of high T2 signal with associated minimal restricted diffusion centered within the middle cerebellar peduncles. There is no evidence of intracranial hemorrhage or mass. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is mild scattered paranasal sinus mucosal thickening.
Lesions involving the splenium of the corpus callosum and bilateral middle cerebellar peduncles likely represent a toxic-metabolic leukoencephalopathy and less likely thrombotic microangiopathy or hemolytic uremic syndrome.Discussed with Dr. BUERKI at 11:30 AM on 4/18/15.