MRI BRAIN STROKE PROTOCOL WITHOUT CONTRAST:
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.
BRAIN:
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.
INTRACRANIAL ANGIOGRAM:
Anterior circulation: No flow-limiting stenosis or aneurysm.
Posterior circulation: No flow-limiting stenosis or aneurysm.
Dural venous sinuses: Patent.
Additional comment: None.
EXTRACRANIAL ANGIOGRAM:
Limited and nondiagnostic.
IMPRESSION:
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.