Diagnosis: Altered mental status, unspecified Unspecified convulsionsClinical question: seizure etiology The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a punctate enhancing focus present in the right putamen of the basal ganglia which is associated with high signal on FLAIR MRI and a punctate hypointensity on susceptibility imaging.There are several punctate foci of hypointensity on susceptibility imaging present within the pons and basal ganglia.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.Normal vascular flow voids are present in the distal carotid and left vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus. The right vertebral artery flow-void is not distinct distally.The visualized portions of the paranasal sinuses demonstrate scattered opacities.. The visualized portions of the mastoid air cells demonstrate minor opacities. The visualized portions of the orbits are intact.
1.There is a punctate enhancing lesion present within the putamen of the right basal ganglia. It is associated with a microhemorrhage. Most likely this is vascular related; it is, however, nonspecific and could be the result of an entity other than a vascular related insult. A follow-up exam would help assess this further.2.There are several punctate microhemorrhages in the brainstem and basal ganglia. Given their distribution most likely these are related to hypertension.3.The right vertebral artery is not identified distally. This could very well be a result of a hypoplastic right vertebral artery