Clinical question: History of CVA. Signs and symptoms: Weakness. Non-enhanced head CT:Examination demonstrate an area of low-attenuation involving the inferior aspect of the left cerebellum highly concerning for an acute/early subacute nonhemorrhagic left pica territory stroke. This lesion measures approximately 20.5 x 20-mm in size. No evidence of hemorrhagic component is detected. This finding is best appreciated on axial image number 8. There is also an additional similar area of low-attenuation involving the tip of a right occipital lobe representing an additional focus of non-hemorrhagic acute/early subacute cortical stroke. Few additional very small patchy areas of low attenuation are also noted in the superior aspect of left cerebellum which are also concerning for additional areas of cortical stroke of indeterminate age (due to very small size).Additional foci of low-attenuation involving high convexity left frontal lobe cortex which is concerning for additional foci of a stroke. None of this finding is associated with a hemorrhagic component.Focal area of high density within the upper pons with extension into the left cerebellar peduncle is present. This finding measures approximately 10 x 7-mm in size. The finding could represent a small area of hemorrhage other possibility of mild calcification from a cavernous malformation cannot be entirely ruled out. There are no prior exams for comparison. This lesion can be further evaluated with a dedicated MRI of the brain.There is a small vessel ischemic disease. No evidence of midline shift or hydrocephalus.Above described findings were discussed with the referring clinical physician Dr. Eaton Kelly pager number 3051 at the time of interpretation. If
1.Multiple foci of acute/early subacute nonhemorrhagic vertebral basilar system strokes in the left pica territory, right occipital lobe and left superior cerebellar artery.2.High convexity left frontal stroke likely subacute.3.Small vessel disease of indeterminate age.4.Small foci of increased density in the pons and the base of the left cerebellar peduncle which could represent small area of hemorrhage or a cavernoma. Follow-up with an MRI is recommended. 