Clinical question: 23 year-old female with sickle cell disease and new onset of headaches. Signs and symptoms: New onset headaches. Nonenhanced head CT:No detectable acute intracranial hemorrhage, edema, mass-effect, midline shift or hydrocephalus.Very subtle foci of low attenuation in the periventricular and subcortical white matter of bilateral cerebral hemispheres are likely result of prior strokes of indeterminate age considering provided clinical history of sickle cell disease. There are no prior exams for comparison. CT is insensitive for early detection of acute ischemic strokes. Consider MRI for further evaluation.The cortical sulci and ventricular system is not CSF cisterns are unremarkable.Calvarium is intact.Limited view of paranasal sinuses demonstrate chronic left maxillary, left ethmoid and minimally of the sphenoid chronic sinus disease.
1.No acute intracranial process. CT is insensitive for early detection of acute ischemic strokes.2.Few small periventricular and subcortical foci of low-attenuation although nonspecific considering history of sickle cell disease there are suspected of age indeterminate strokes pain knee small vessel vascular territory.3.Partially visualized paranasal sinuses demonstrate chronic sinusitis of the left maxillary and left ethmoid air cells.4.Unremarkable calvarium.