Demographics:
5 years old, Male
Indication:
Altered mental status
Findings
- T2/FLAIR hyperintensity and restricted diffusion in the left insula and subinsular region
- Additional multifocal areas of patchy T2/FLAIR hyperintensity involving the upper cervical spinal cord, pons, right thalamus, bilateral basal ganglia, cerebral cortex, and subcortical white matter
- No associated enhancement
- No acute hemorrhage, mass effect, or hydrocephalus
- Fluid and aerated secretions layering in the right maxillary sinus
Diagnosis
Acute disseminated encephalomyelitis (ADEM)
Sample Report
Multifocal areas of patchy T2/FLAIR hyperintensity involving the upper cervical spinal cord, pons, right thalamus, bilateral basal ganglia, cerebral cortex, and subcortical white matter, most extensively involving the left insula and subinsular region without associated enhancement. Given patient age, this appearance most likely relates to acute disseminated encephalomyelitis (ADEM) or vasculitis. Recommend correlation with CSF analysis.
No acute hemorrhage, mass effect, or hydrocephalus.
Fluid and aerated secretions layering in the right maxillary sinus, which can be seen with acute sinusitis.
Discussion