Clinical question: Evaluate for vascular dementia. Signs and symptoms: Sudden onset of confusion. Nonenhanced brain MRI:No evidence of acute intracranial process and in particular no evidence of acute ischemic stroke.Examination demonstrate mild patchy periventricular and to a lesser degree subcortical foci of flair hyperintensity bilateral cerebral hemispheres. Minimal similar signal changes are also noted in the pons. Although nonspecific considering patient's stated age of 87 this appearance is often result of chronic small vessel ischemic strokes. The cortical sulci and ventricular system as well as the CSF spaces remain within normal for age.The signal void of major intracranial arterial branches are identified.Calvarium and soft tissues of the scalp are unremarkable.Unremarkable images through the orbits.Mild chronic sinus disease is noted.
1.No acute intracranial process.2.Periventricular, subcortical and pontine foci of flair hyperintensity suggestive of mild chronic nonhemorrhagic small vessel ischemic strokes.3.Unremarkable nonenhanced brain MRI otherwise