Lupus cerebritis and altered mental status. There is a subcentimeter mildly T2 hyperintense lesion with restricted diffusion in the posterior left cerebellar hemisphere. Punctate foci of high T21 signal without restricted diffusion in the right thalamus and left basal ganglia and thalami. There is also trace bilateral periventricular white matter T2 hyperintensity. There is no evidence of intracranial hemorrhage or mass. There is no abnormal intracranial enhancement. There is perhaps mild diffuse cerebral volume loss. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, mastoid air cells, and scalp soft tissues are grossly unremarkable. There is a small amount of secretions in the posterior right ethmoid sinus.
1. Acute infarct in the posterior left cerebellar hemisphere, which may be related to lupus vasculitis. 2. Punctate foci of high T21 signal without restricted diffusion in the right thalamus and left basal ganglia and thalami may represent prior lacunar infarcts related to lupus vasculitis. 