Clinical question: 70-year-old with ovarian carcinoma and history of hemorrhagic stroke. Altered mental status. Nonenhanced CT of brain:There is a large area of encephalomalacia in the right posterior temporal -- occipital region with ex vacuo dilatation of adjacent cortical sulci and ventricle. There was a large acute hemorrhagic stroke on this side on prior study.There is a subtle area of cortical and subcortical low attenuation in high convexity of the left posterior frontal and precentral stroke post which may represent a small cortical stroke of indeterminate age. This finding was not present on prior exam. Please correlate with history and follow up with an MRI is recommended. There is no evidence of hemorrhage. No midline shift is detected.
1.A very subtle small left precentral sulcus low-attenuation of cortex and subcortical white matter which is too small to determine the age however it is a new finding since prior examination. Correlate with history and follow-up with an MRI for acute ischemic stroke.2.Previously noted large area of hemorrhage in the right posterior temporal -- occipital junction has evolved into a large area of encephalomalacia and minimal demineralization. Unremarkable exam otherwise.