75-year-old female with mental status changes status post fall on face. Evaluate for acute bleed. Extensive areas of low-attenuation in the deep, subcortical, and periventricular white matter consistent with small vessel ischemic disease of indeterminate age. They appear grossly stable when comparing to prior MRI of the brain. There is no evidence of intracranial hemorrhage, mass or edema. The ventricles and basal cisterns are normal in size and configuration.Additionally, there is a mottled appearance to the bones of the skull base and frontal bone that is of uncertain etiology. Given patient's history of malignancy, bone metastasis is a differential consideration.The visualized paranasal sinuses and mastoid air cells are normally pneumatized.
1. Extensive small vessel ischemic disease of indeterminate age.2. Mottled appearance of the bones of the skull base and frontal bone is of uncertain etiology. Given patient's history of malignancy, metastatic disease to bone is a differential consideration. Nuclear medicine bone scan may be helpful for further evaluation as clinically indicated.