Neuro_MR_Brain: 88 F, acute delirium.

MRI BRAIN STROKE PROTOCOL WITHOUT CONTRAST:

CLINICAL HISTORY: 86-year-old woman with sudden onset acute delirium, history of essential thrombocythemia and parkinsonism. Evaluate for acute stroke or other acute intracranial process versus signs of frontotemporal dementia.

FINDINGS:

BRAIN:

Exam is significantly degraded by motion.

Parenchyma: There is restricted diffusion involving the anterior column of the right fornix (images 3:16-17), most likely representing acute infarct. No mass effect.

Scattered T2/FLAIR hyperintense white matter foci, nonspecific though compatible with chronic microvascular ischemic disease. There is mild to moderate parenchymal volume loss, commensurate with age. There is T1 and FLAIR hyperintensity overlying the bilateral frontal poles (image 6:16-17), which appears to show evidence of hemosiderin on GRE images, which are likely sequela of prior trauma.

Ventricles and extra-axial spaces: Evidence of old subarachnoid hemorrhage as above. Ventricular prominence commensurate with diffuse cerebral volume loss.

Orbits: Status post bilateral lens replacement.

Visualized paranasal sinuses: Clear.

Mastoid air cells: Clear.

Bones: Normal.

INTRACRANIAL ANGIOGRAM:

Anterior circulation: Motion degraded, without definite evidence of aneurysm or flow limiting stenosis. There is an azygos A2 which arises from dominant left A1.

Posterior circulation: No flow-limiting stenosis or aneurysm.

IMPRESSION:

1. Acute infarct of the right fornix anterior column.

2. Motion degraded MRA images, but no definite flow-limiting stenosis or aneurysm. Intracranial vessel irregularity due to motion and/or intracranial atherosclerosis.

(Fornix infarct)