Neuro_MR_Brain: 25 F, hx SLE p/w AMS

MRI BRAIN WITH AND WITHOUT CONTRAST:

CLINICAL HISTORY: 25 years of age, Female, with history of bipolar disorder, polysubstance abuse, lupus, questioned multiple sclerosis, strong family history of autoimmune disease, who present as transfer from Mendocino hospital as transfer for higher level of care for her ongoing progressive confusion and memory loss.

FINDINGS:

The exam is motion degraded.

Parenchyma: Multiple T2 hyperintensities with corresponding hypointensity on T1 are present primarily involving the corpus callosum. 

The diffusion sequences demonstrate multiple punctate foci of reduced diffusion scattered throughout the brain including the right pons. Some of these appear to demonstrate enhancement on the post gadolinium sequences. There are also small chronic lacunar infarcts throughout the white matter.

Ventricles and extra-axial spaces: Appropriate for age.

Orbits: Normal.

Visualized paranasal sinuses: Clear.

Mastoid air cells: Clear.

Bones: Normal.

Additional comment: None.

 

INTRACRANIAL ANGIOGRAM:

Anterior circulation: No flow-limiting stenosis or aneurysm. There are no areas of segmental narrowing in the proximal larger divisions although the exam is slightly limited by motion artifact.

Posterior circulation: No flow-limiting stenosis or aneurysm.

Dural venous sinuses: Patent.

Additional comment: None.

PERFUSION:  

Normal. 

 

IMPRESSION:

1.  Motion degraded exam. There are multiple foci of acute and subacute infarcts intermixed with chronic infarcts throughout the brain including the right pons, right cerebellum and bilateral basal ganglia, some which are new from the recent comparison MRI. Differential includes vasculitis or possibly embolic stroke. Consider echocardiogram to rule out endocarditis in a patient with reported drug use history.

2.  Normal perfusion and MRA. There are no MRA findings of vasculitis.