Clinical question: Is there evidence of bleed. Signs and symptoms: Altered mental status. Non-infused head CT:Examination demonstrates small foci of low attenuation involving the cortex of left frontal lobe in the distribution of left middle cerebral artery and is consistent with acute/early subacute cortical stroke. Follow-up with an MRI is recommended. There is no evidence of hemorrhage associated with this finding. This finding is best appreciated on axial images 15 through 17.Few small periventricular foci of low attenuation are primarily on the left side and are concerning for a small was ischemic stroke of indeterminate age. Considering that all findings are on the left side possibility of high-grade stenosis of the larger proximal vessel of the MCA or left internal carotid artery should be considered and follow all but his CTA is recommended.There is no detectable abnormality of right hemisphere. The ventricular system and midline is within normal.Calvarium is intact. Visualized mastoid air cells, orbits and paranasal sinuses are unremarkable.
1.Acute left middle cerebral artery stroke in the frontal lobe with no hemorrhagic component.2.Findings of a small vessel disease primarily in the left hemisphere.3.There is no evidence of hemorrhage, is significant mass effect, midline shift or hydrocephalus.4.Follow-up with an MR/MRA and or CTA is recommended.