Clinical question:syncope. Signs and symptoms: Syncope with altered mental status. Nonenhanced head CT:Examination demonstrate a well demarcated area of low attenuation in the left caudate and globus pallidus highly suspect that of an acute left basal ganglial infarct. There is no appreciable mass effect but this finding. Recommend follow-up with an MRI. There is no evidence of hemorrhage. Examination also demonstrate mild bilateral patchy areas of low attenuation of subcortical white matter highly suspected for small vessel ischemic disease of indeterminate age.Ventricular system and the CSF cisterns remain within normal.There is mild calcification and tortuosity of bilateral cavernous carotid.There is severe tortuosity and aneurysmal dilatation of the basilar artery (dolichoectatic basilar) representing atherosclerotic disease. Follow up with an MRA or a CTA is recommended.
1.Highly suspected acute nonhemorrhagic lacunar infarct of left caudate and globus pallidus. 2.Mild small vessel ischemic strokes of indeterminate age in the supratentorial brain parenchyma.3.Dolichoectatic basilar artery with calcification.4.Recommend follow-up with an MRI and MRA.