22-year-old male with CML status post stem cell transplant with acute mental status changes. Diffuse low density seen throughout the subcortical and periventricular white matter, indicating significant white matter disease, grossly unchanged from MRI performed 5/1/2008. Diffuse intracerebral edema resulting in effacement of sulci and narrowing of the lateral ventricles is unchanged to slightly progressed compared to the prior MRI, though significantly increased from prior CT. There is no evidence of intra-cranial hemorrhage or abnormal extra-axial fluid collections. The ventricles are midline, with no evidence of midline shift.The visualized calvarium and other osseous structures are within normal limits. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.
Significant diffuse white matter abnormality and cerebral edema, slightly progressed from MRI performed 5/1/2008. Differential considerations include drug reaction or auto-immune reaction to stem cell transplant, less likely infection. Contrast-enhanced MRI may be considered to further evaluate this abnormality.Results were discussed with the clinical service at the time of interpretation.