Diagnosis: Altered mental status, unspecified Cerebellar stroke syndromeClinical question: r/o acute infarcts or enhancementSigns and Symptoms: altered mental status MRI of the brainNo diffusion weighted abnormalities are appreciated.There is encephalomalacia involving the posterior aspect of the right cerebellar hemisphere which was in the subacute phase and 2013. There is associated asymmetric dilation of the fourth ventricle. A smaller focus of encephalomalacia is present in the left temporal lobe anteriorly. Another small focus of encephalomalacia is present along the left cerebellar hemisphere.Redemonstration of a T2 and FLAIR hyperintense focus centered in the left thalamus.Periventricular and subcortical white matter T2 and FLAIR hyperintense punctate foci of a mild degree are present. The lateral ventricles are fairly large but unchanged compared to a recent head CT.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and 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 visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.The pituitary gland measures 10 mm in height but is unchanged since prior exam 9/20/2013.MRA brain:Exam is somewhat degraded due to patient motion which would obscure more subtle abnormalities.Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries. The A2 segment is azygos.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The posterior communicating arteries are not readily identified. The vertebral arteries are similar in size.
1.No evidence for cerebrovascular occlusive disease.2.No evidence for intracranial aneurysm.3.No evidence for acute cerebral infarction.4.There is redemonstration of moderate-sized focus of encephalomalacia involving the right cerebellar hemisphere and smaller foci of encephalomalacia in the left cerebellar hemisphere and anterior portion of the left temporal lobe which were present on the recent CT head exam from 11/30/15 and have not changed. These are likely vascular related.5.There is redemonstration of an old lacunar infarct in left thalamus.6.The lateral ventricles appear large. Although this could be a result of brain atrophy possibility of normal pressure hydrocephalus cannot be excluded. Please correlate with patient's clinical symptoms.7.Enlargement of the pituitary gland is relatively stable compared to prior exams. Possibility of a pituitary abnormality cannot be excluded. Please correlate with patient's clinical history, signs and laboratory tests8.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related. 