60 year old female who presents with seizure with a history of a lung mass. Evaluate for intracranial hemorrhage or metastases. Given the lack of intravenous contrast, evaluation for metastatic lesions is limited. Given these limitations, the following observations are made:Brain:There is a large area of hypoattenuation in the high convexity of the left frontal lobe. There is associated subtle ex vacuo dilatation of the lateral ventricle and loss of surrounding cortex. These findings may represent a remote infarct and encephalomalacia, however, metastatic disease cannot be excluded on this noncontrast examination. There is a area of hypodensity in the right posterior subcortical periventricular white matter adjacent to the right trigone. There is no associated mass effect, ex vacuo dilation, or enlargement of the sulci. These findings likely represent vasogenic edema. It is less likely a remote infarct. Additionally, there is an area of hypodensity within the left cerebellum. This likely represents encephalomalacia from prior infarct, however, these findings may possibly represent an arachnoid cyst. There is no evidence of intracranial hemorrhage or mass.There are multiple scattered hypodensities within the periventricular and deep white matter which are age indeterminate and nonspecific but may be related to chronic small vessel ischemic disease. It should be noted that CT is insensitive in detecting acute ischemic infarct an MRI can be considered for further evaluation if clinically indicated.The basal cisterns are normal in size and configuration. There is no effacement of the cortical sulci. There is no mass effect or midline shift.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.Neck/cervical spine:No evidence of malalignment or acute fracture. A lytic lesion is noted in the T2 vertebral body. The posterior cortex of the vertebral body is eroded. There is no associated soft tissue abnormality on this limited non-infusion study. No evidence of canal stenosis. There is multi-level mild degenerative disk disease. There is multi-level disk bulge from C3/C4 to C6/C7. There is no evidence cervical spinal canal stenosis. The neuroforamina are patent bilaterally.
1. Hypoattenuation in the left frontal lobe and right posterior temporal lobe. These findings likely represent vasogenic edema secondary to metastatic disease versus encephalomalacia from a remote infarct. Given the limitations in detecting metastatic disease in a non-enhanced CT examination, further evaluation with contrast-enhanced CT or MRI is recommended. These findings and recommendation were relayed to the emergency department via the STAT consult system.2. There is a lytic lesion in the T2 vertebral body which may represent a metastatic lesion. A bone scan may help further evaluate.  3. Multiple scattered hypodensities within the periventricular and deep white matter, which are age indeterminate and nonspecific but may be related to chronic small vessel ischemic disease. There is no evidence of intracranial hemorrhage. It should be noted that CT is insensitive in detecting acute ischemic infarct and MRI can be considered for further evaluation if clinically indicated.4. Hypodensity within the left cerebellum. This likely represents encephalomalacia from a prior infarct, however, these findings may possibly represent an arachnoid cyst. 