Clinical question: CNS Nocardia, now with personality changes. Signs and symptoms: Personality changes, change in behavior. Nonenhanced brain MRI:After completion of nonenhanced portion of the exam the study was terminated due to patient's refusal to continue.Examination demonstrates no evidence of an acute or new finding since prior exam when compared with nonenhanced component of the prior brain MRI examination from 6-3-15.Well-demarcated focus of FLAIR and T2 hyperintensity in the splenium of corpus callosum believed to represent a fungus ball remains similar to prior study in signal and size. Extensive surrounding FLAIR hyperintensity consistent with vasogenic edema of the corpus callosum also remains identical to prior study in extent.Additional multiple small foci of FLAIR hyperintensity in bilateral cerebral hemisphere demonstrate no convincing evidence of change in size, extent or numbers.Mildly dilated supratentorial ventricular system without deviation of midline also remain similar to prior study in measurements. The cortical sulci and CSF cisterns remain widely patent and stable since prior exam.The signal void of major intracranial arterial branches are identified.The signal intensity of intracranial venous sinuses are within normal.Images through the orbits, paranasal sinuses and mastoid air cells are unremarkable.
1.No detectable acute or convincing evidence of any new finding since prior MRI exam.2.Stable findings of presumed Nocardia infection since prior exam when compared to the prior study.3.Mild prominence of supratentorial ventricular system and generalized prominence of cortical sulci without deviation of midline or interval change since prior study.4.Examination was performed without the benefit of intravenous contrast as patient refused to continue with the exam.