Reason: 55yo M with AML, thrombocytopenia/neutropenia with new headache and also R eye twitching, please eval for any mass lesion such as abscess. Artifact related to dental hardware markedly limits evaluation of the frontal and temporal lobes, particularly on the gradient echo based sequences. There is no evidence of restricted diffusion within the non obscured portions of the brain to suggest acute ischemic infarction. There are several subcentimeter foci of parenchymal susceptibility artifact within the left superior frontal gyrus, left inferior frontal gyrus, left cingulate gyrus, and right hippocampus without associated edema or mass effect compatible with chronic microhemorrhages in a nonspecific distribution. Otherwise, no parenchymal signal abnormalities are detected. No intraparenchymal pathological enhancement is identified. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. There is minimal downward displacement of the cerebellar tonsils, which may be a normal variant. There is mild mucosal thickening within the ethmoid air cells and partially visualized left maxillary sinus. There is diffuse marrow replacement compatible with clinical history of leukemia.
1.Dental hardware artifact obscures portions of the frontal and temporal lobes. Within this limitation:2.No evidence of acute infarction, mass effect, or abscess as clinically questioned.3.Few scattered small chronic appearing microhemorrhages in a distribution involving predominantly subcortical white matter without evidence of associated edema or mass effect. This is nonspecific. Although it may relate to the patient's known thrombocytopenia it remains nonspecific.4.Mild mucosal thickening within the paranasal sinuses.5.Diffuse marrow replacement compatible with clinical history of leukemia.