Clinical question: 56-year-old male with altered mental status, history of CVA, now with mental status change and focal left-sided weakness. Please evaluate for subacute stroke/other intracranial process. Signs and symptoms: Left-sided weakness, slurred speech. Non-infused CT of brain:Examination redemonstrates an old right basal ganglia lacunar infarct.No evidence of new detectable ischemic stroke, hemorrhage, edema, mass effect or midline shift.Cortical sulci, ventricular system and all CSF cisterns remain similar to prior study and within normal limits. Considering provided clinical data an MRI examination would be most helpful for detection of early acute stroke.Calvarium is intact.Limited real paranasal sinuses demonstrate minimal right maxillary chronic sinusitis.Mastoid air cells and middle ear cavities are pneumatized.
1.No definite acute detectable new ischemic stroke or hemorrhage.2.Stable previously described findings of right sided lacunar infarct.3.Overall stable exam. 