Clinical question: 65 year-old female with left tonsillar squamous cell carcinoma. Now presenting with seizure episode. Rule out hemorrhagic CVA, etc. Signs and symptoms: Seizures Non-infused CT of brain:A new area of low-attenuation involving the cortex and subcortical white matter of the left frontal lobe (axial images 19 and 20) is noted. There is subtle mass effect with this finding. There is no evidence of hemorrhage associated with this finding. This finding is believed to represent a small acute cortical stroke. Considering patient's history possibility of a metastatic lesion should also be considered. Further study with an infused head CT or an MRI is recommended.No evidence of hemorrhage, mass effect, midline shift or hydrocephalus. Calvarium is intact. Very extensive degenerative changes of cervical spine at C1 -- C2 level is noted.
1.New foci of low-attenuation in the left frontal lobe as detailed. Finding is concerning for ischemic stroke and considering patient's history possibility of a metastatic lesion cannot be entirely ruled out. Follow-up study would be effusion is recommended.2.No evidence of hemorrhage a standard but is questioned or any additional findings.