70 years Male (DOB:10/6/1945)Reason: Eval for signs of meningitis, infection and R/O PRES syndrome due to Tacrolimus History: Intractable Headache, Nausea, VomitingPROVIDER/ATTENDING NAME: MARK F MYREN GABRIEL T SAYER The CSF spaces are appropriate for the patient's stated age with no midline shift. On susceptibility imaging there are multiple punctate foci of signal loss scattered in the cerebellum, subcortical white matter and periventricular white matter. There is also a gyriform component of signal loss and susceptibility imaging in the right frontal gyrus.There is a T2 and FLAIR hyperintense focus measuring 8 mm in size located in the right occipital lobe it involves gray matter. It is not associated with contrast enhancement, susceptibility effect or diffusion restriction.No abnormal enhancing mass lesions are appreciated intracranially. 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 eyeball lenses are thin.
1.There is no evidence for intracranial meningitis or abscess and no evidence for posterior reversible encephalopathy syndrome.2.There is a mild to moderate degree of multiple microhemorrhages scattered throughout the brain parenchyma. This is nonspecific. One possibility is it could be related to amyloid angiopathy though it could be related to anticoagulation or other etiologies.3.Findings suggest an old lacunar infarct in the right occipital lobe