89-year-old female status post exploratory laparotomy for lysis of adhesions for small bowel obstruction now with right facial droop and tongue deviation. There is no evidence of intracranial hemorrhage, mass or edema. Multiple patchy hypodensities in a periventricular distribution throughout the subcortical white matter consistent with advanced small vessel disease. Small vessel disease of undetermined age may be further evaluated with an MRI if there is clinical suspicion of acute ischemia. Prominence of the sulci and ventricles are proportional. The skull base is radiographically normal. The calvaria demonstrates multiple patchy foci of high density and cortical thickening consistent with Paget's disease. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.
1. Small vessel disease, age indeterminate. If there is clinical concern for acute ischemia, an MRI may be considered.2. Paget's disease affects the skull.