Altered mental status and possible malignancy. Some of the images are degraded by patient motion. There is a T2 hyperintense lesion in the splenium of the corpus callosum that measures up to 20 mm and multiple scattered punctate foci of high T2 signal in the bilateral cerebral hemisphere white matter. Many of the lesions demonstrate mild restricted diffusion. There is no definite evidence of gross intracranial hemorrhage. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.
1. Multiple scattered white matter lesions, including within the splenium of the corpus callosum and in the bilateral cerebral hemispheres may represent late subacute infarcts perhaps superimposed upon chronic small vessel ischemia, or possibly form of infectious process, versus less likely metastatic disease given the atypical distribution. However, the assessment is limited by the lack of intravenous contrast. 2. No evidence of gross acute intracranial hemorrhage, although the images are somewhat degraded by patient motion.