71-year-old female status post right TKA with history of CVA. As increased irritability and decreased responsiveness. Rule out subdural hematoma or infarction. The examination demonstrates some periventricular hypodensity consistent with small vessel ischemic disease. In the left temporal region there is an area of hypodensity which may or present area of acute ischemia. The appearance is somewhat atypical however with a central area of relative hyperdensity. I cannot exclude the possibility of prior hemorrhage or even underlying mass lesion.. No significant mass-effect is seen. I would recommend obtaining an MRI of the brain with contrast to further evaluate this region.Bone windows reveal no osseous abnormality.
Small vessel disease an area of atypical density along the left temporal lobe. Possibilities include an area of subacute ischemia versus evolving hematoma (possibly evolution of hemorrhagic transformation of an infarct) or less likely mass lesion. MRI of the brain with contrast is recommended to fully evaluate.