 Brain MRI: There are extensive patchy areas of T2 hyperintensity within the supratentorial and infratentorial white matter, as well as in the bilateral basal ganglia and thalami. There are also areas of susceptibility effect in the left cerebellar hemisphere, vermis, left insula, and bilateral basal ganglia, with what may represent mild vasogenic edema. However, there is no evidence of acute infarction. There is no evidence of abnormal enhancement or tumors within the brain. There is no midline shift or herniation. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. Brain MRA: There is no evidence of significant steno-occlusive lesions. There is no evidence of aneurysms.Neck MRA: There is no evidence of significant steno-occlusive lesions.
1. Extensive supratentorial and infratentorial white matter abnormality, as well as abnormality involving the bilateral deep grey nuclei, along with what appears to be hemorrhage within the left cerebellar hemisphere, vermis, left insula, and bilateral basal ganglia. These findings may represent acute upon chronic hypertensive encephalopathy and perhaps hemorrhagic encephalitis from other causes.2. No specific evidence of nonhemorrhagic acute infarcts or tumors.3. No evidence of significant steno-occlusive lesions in the head and neck arteries.