98-year-old with altered mental status x 3 days with similar episode 3 weeks and 1 week ago. Please evaluate for bleeding or mass effect. History of dementia, arrhythmia. Diffuse areas of subcortical and periventricular white matter hypodensity likely represents small vessel ischemic disease of indeterminate age and appears approximately similar to the prior examination. However, if there is concern for an acute infarction, an MRI may be considered for further evaluation. There is no evidence of intracranial hemorrhage, mass or midline shift.Ex vacuo dilation of the ventricles and prominence of the sulci indicates marked corticomedullary volume loss.Thickening of the diploic space with patchy areas of sclerosis raises the question of Paget's disease. The left-sided mastoid air cells are underpneumatized. The remaining visualized paranasal sinuses and mastoid air cells are normally pneumatized.
No definite acute findings. Small vessel ischemic disease of indeterminate age, similar to the prior study. However if there is concern for an acute infarction, an MRI may be considered for further evaluation.