76-year-old male status post head injury; evaluate for ICH There is no evidence of acute intracranial hemorrhage, mass or edema. Extensive areas of nonspecific patchy and confluent hypoattenuation are seen in the periventricular and subcortical white matter, likely representing small vessel ischemic disease of indeterminant age.There is an extra-axial soft tissue density in the interhemispheric fissure measuring 7 x 8 mm (image 11, series 3) and 11 mm in height on the sagittal images. The soft tissue density appears to be connected to the left internal carotid artery and may represent an anterior communicating artery aneurysm. Recommend MRI/MRA for further evaluation. The ventricles and basal cisterns are normal in size and configuration.Soft tissue swelling is seen overlying the left frontal region. The calvaria and skull base are radiographically normal without evidence of fracture. The visualized paranasal sinuses, middle ear cavities and mastoid air cells are normally pneumatized.
1. No acute intracranial hemorrhage. Extensive small vessel ischemic disease of indeterminate age. 2. Left frontal soft tissue swelling without underlying fracture. 3. Soft tissue density in the interhemispheric fissure as described above suspicious for ACOM aneurysm. Recommend MRI/MRA for further evaluation.These findings were discussed with the emergency room (#56807) at the time of dictation.