Altered mental status, evaluate for brain metastases. There is no restricted diffusion to suggest acute infarction. There are scattered foci of increased T2/FLAIR signal within the bilateral cerebral white matter which do not appear significantly changed compared to the 8/20/2016 examination allowing for differences in technique. Previously seen signal abnormality on 8/8/2016 exam predominantly involving the bilateral posterior cerebral hemispheres likely related to PRES no longer seen. There is no evidence of acute intracranial hemorrhage or mass. There is an unchanged punctate focus of susceptibility in the left frontal lobe, which is nonspecific, but likely related to trace mineralization or chronic hemosiderin. No pathologic enhancement is identified. The ventricles and sulci are unchanged including a normal variant cavum septum pellucidum. There is no midline shift or herniation. The major cerebral flow voids are intact. There is diffusely decreased T1 signal within the bone marrow with a few scattered areas of preserved increased T1 signal which is nonspecific and may be related to chronic anemia.
1.No evidence of acute infarct or other acute intracranial abnormality.2.Few scattered areas of signal abnormality within the cerebral white matter which are nonspecific and not significantly changed compared to 8/20/2016. These may represent chronic small vessel ischemic changes or sequela of other injury.3.No evidence of intracranial metastases as questioned. 