Neuro_MR_Brain: 52 M, history of stroke, bone marrow transplant, new seizure and AMS.


CLINICAL HISTORY: 52 years of age, Male, history of stroke now presenting with altered mental status and seizure. Evaluate for stroke versus vasculitis.

FINDINGS: The FLAIR sequence is limited due to motion.


Parenchyma: FLAIR hyperintensity and edema within the bilateral mesial temporal lobes with new restricted diffusion in the right greater than left hippocampal tails. No evidence of acute stroke or hemorrhage. Redemonstration of hemosiderin staining, encephalomalacia, and chronic laminar necrosis from prior left occipital lobe infarct. Scattered T2/FLAIR hyperintensities in the subcortical white matter are nonspecific but unchanged from prior.

Ventricles and extra-axial spaces: No ventriculomegaly. Nearly complete resolution of previously seen subdural collections.

Orbits: Normal.

Visualized paranasal sinuses: Clear.

Mastoid air cells: Clear.

Bones: Normal.

Additional comment: There is prominence of the pituitary gland with an upward convexity of the superior border and margin of the pituitary gland within the sella turcica.


Anterior circulation: No flow-limiting stenosis or aneurysm.

Posterior circulation: No flow-limiting stenosis or aneurysm.

Dural venous sinuses: Patent.

Additional comment: None.


Limited and nondiagnostic. 

1.  New bilateral mesial temporal lobe signal abnormality and edema with restricted diffusion in the hippocampi tails. Differential diagnosis includes  infection such as herpes encephalitis or post-ictal changes. Consider CSF sampling as clinically indicated.

2.  No flow-limiting stenosis or aneurysm.

3.  Pituitary gland prominence with upward convexity of the superior border and margin. Correlate with pituitary function tests and further evaluation with a pituitary protocol brain MRI with contrast when the patient is able to tolerate such an exam.

4.  Note that contrast was not administered as the patient was unable to complete the entire exam. 

(HHV-6 encephalitis)

Accession: CL27388662

Study description: MR BRAIN