Clinical question: Evaluate for acute or subacute subdural hematoma. Signs and symptoms: Altered mental status with unclear history. Nonenhanced head CT:Examination demonstrates very extensive subcortical and periventricular low-attenuation white matter which considering patient's age likely are presenting advanced small vessel ischemic strokes of indeterminate age.There is also a focus of low attenuation involving the cortex and subcortical white matter of the left posterior temporal -- and which has the appearance of a cortical stroke or with indeterminate age. Similar larger finding in the right posterior temporal -- occipital region is also present and is suspected of an acute to early subacute ischemic stroke.No evidence of acute intracranial hemorrhage, midline shift or hydrocephalus.Recommend follow-up with an MRI examination.
1.Advanced small vessel ischemic strokes of indeterminate age.2.Regions of cortical stroke in the bilateral posterior temporal -- occipital regions which are also indeterminate as of their age. Recommend follow up with MRI exam.3.No detectable acute intracranial hemorrhage, midline shift or hydrocephalus.