Clinical question: Rule out intracranial bleed. Signs and symptoms: multiple falls. Unenhanced head CT:Findings highly suspected for moderate to advanced small vessel disease of indeterminate age are noted. The large area of low-attenuation in high convexity right frontal lobe white matter with associated mass effect suspected for edema. Recommend further follow-up with an enhanced CT or an MRI with infusion to exclude possibility of malignancy. This is a new finding since prior examination from 2006.There is no evidence of hemorrhage, hydrocephalus or midline shift. Calvarium is intact. Extensive right maxillary sinus opacification and otherwise unremarkable visualized paranasal sinuses.There is also subtle low attenuation of the cortex of the right posterior high convexity frontal lobe suspected for subacute ischemic disease.
1.High convexity right frontal low attenuation of white matter has the appearance of vasogenic edema and recommend further follow-up with an enhanced study to exclude underlying malignancy.2.Small vessel disease of indeterminate age.3.Subtle low attenuation of the right posterior high convexity frontal cortex may represent a focal area of subacute stroke.4.Recommend follow-up with an enhanced MRI for further evaluation of the above findings.