65-year-old male with cerebellum dysfunction and recent fall There is a focus of hypodensity involving the right precentral gyrus white and gray matter corresponding to the area of restricted diffusion seen on prior MRI and likely represents an evolving subacute infarct. Subtle hyperdensity is seen along the precentral gyrus cortex which may represent laminar necrosis versus punctate petechial hemorrhage.A few hypoattenuating foci are seen in the periventricular region which is nonspecific but may represent small vessel ischemic disease of indeterminate age. There is no mass-effect, midline shift or edema. The ventricles and basal cisterns are normal in size and configuration.Minimal soft tissue swelling seen overlying the right parieto-occipital region without underlying fracture. The calvaria and skull base are radiographically normal. Partial opacification of the left maxillary sinus containing high density material which may represent inspissated mucus versus fungal sinusitis, grossly unchanged. The remaining visualized paranasal sinuses and mastoid air cells are normally pneumatized.
1. Findings consistent with an evolving right precentral gyrus subacute infarct as seen on the prior MRI. CT is insensitive for the early diagnosis of acute nonhemorrhagic infarct. MRI brain can be considered if clinically indicated.2. Redemonstration of left maxillary sinus sinusitis containing high density material which may represent inspissated mucus versus fungal sinusitis.