Clinical question: evaluate for bleed. Signs and symptoms: Altered mental status. Status post fall. Nonenhanced head CT:Examination demonstrates no evidence of intracranial hemorrhage.Large area of low-attenuation involving the left posterior temporal and extending into the left occipital lobe and further superiorly into the parietal lobe. There is only suspected subtle mass effect and effacement of adjacent cortical sulci in particular in the parietal component. This finding although has the appearance of an old stroke possibility of a subacute component cannot be ruled out. There is no associated hemorrhage. Recommend further follow-up weighted and MRI exam to exclude acute/subacute stroke. One there is no evidence of hemorrhage midline shift or hydrocephalus.Calvarium is intact. Visualized mastoid air cells and middle ear cavities are pneumatized and unremarkable.Debris within bilateral external auditory canals.CT of cervical spine:Images through the skull base are unremarkable. The articulation of C1 and C2 remains within normal no fracture is detected. Degenerative changes of cervical spine with multilevel neural foramina compromise is identified. There is however no evidence of cervical spinal fracture. The alignment the vertebral column is unremarkable. There is however scoliosis.No detectable soft tissue abnormality of the neck.CT of orbits:Examination demonstrates preseptal periorbital swelling likely result of recent trauma. There is no evidence of fracture. The retro-orbital fat is within normal limits. There is normal morphology and density of globes with intact lenses. The extraocular musculature is unremarkable. Visualized paranasal sinuses are unremarkable.
1.Negative CT of cervical spine for fracture. Degenerative disk disease is noted.2.Head CT demonstrates large area of low-attenuation in the left posterior temporal extending to occipital and left parietal lobe. Although large segment of this finding appears as an old cortical stroke there are suspected areas of effacement of cortical sulci in the parietal region may indicate an overlapping acute/subacute new stroke. Recommend further follow-up with an MRI. There is no evidence of posttraumatic intracranial abnormality.3.CT of orbits demonstrate right sided preseptal periorbital swelling likely result of recent trauma. No evidence of fracture or any abnormality in the retroseptal region.