Neuro_MR_Brain: 72 M.

MR Brain with and without Contrast

 

HISTORY: 72-year-old male with clinical concern for stroke versus meningitis.

 

FINDINGS: 

 

Several scattered areas of restricted diffusion are seen involving the bilateral occipital, parietal, and posterior right frontal lobes with associated areas of increased T2 and FLAIR signal abnormality. Many of the lesions involving the occipital and inferior parietal lobes demonstrate associated enhancement and/or intrinsically increased T1 signal consistent with subacute to chronic infarcts. However a few lesions are more representative of early subacute infarcts given the residual restricted diffusion and contrast enhancement. Although the susceptibility weighted sequences are degraded by patient motion, many of these areas of restricted diffusion demonstrate associated areas of susceptibility artifact suggesting either an infectious embolic event or hemorrhagic conversion of small infarcts. A few faint areas of leptomeningeal enhancement are seen along the right parietal lobe.

There is no acute intracranial hemorrhage, mass effect, or midline 

shift. There is prominence of the ventricles and sulci. Scattered and confluent foci of white matter signal abnormality are seen within the periventricular white matter which, in conjunction with the prominence and CSF containing spaces, may be secondary to small vessel ischemic disease in this age group. There is stable mild ventriculomegaly. Abnormal intra-axial or extra-axial fluid collections are not present.

A small left maxillary mucous retention cyst or polyp is present. Bilateral mastoid effusions are present, left worse than right. The orbit, flow-voids at the skull base, and cervicomedullary junction are preserved. The calvarium demonstrates no abnormalities.

Perfusion: Peripheral increased ASL signal in a border zone pattern.

 

IMPRESSION: 

 

1. Subacute to chronic infarcts throughout the supratentorial brain with faint areas of residual leptomeningeal enhancement within the right parietal lobe. These findings may be seen in patients with meningoencephalitis; however, small vessel vasculitis is not excluded.

2. Stable mild ventriculomegaly.

 

3. Peripheral increased ASL signal in a border zone pattern may be seen in patients with low cardiac output.