70 year-old male with syncope and fall; rule out ICH versus fracture BRAIN:There is no evidence of intracranial hemorrhage, significant mass effect or midline shift. Right basal ganglia lacunar infarcts. Patchy hypoattenuating foci are seen in the periventricular and subcortical white matter which are nonspecific but most likely represent small vessel ischemic disease of indeterminate age.There is hyperdensity overlying the left frontal operculum which corresponds to the left frontal lobe cavernoma seen on previous MRI and likely represents dystrophic calcifications. The ventricles and basal cisterns are prominent, consistent with age-related volume loss. The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized. Left phthisis bulbi is noted.CERVICAL SPINE:The cervical spine alignment is anatomic. Vertebral body heights are maintained without evidence of fracture. Paravertebral soft tissues are unremarkable. Moderate degenerative disease affects the cervical spine with multilevel disk protrusions, most prominently affecting C3-C4 and C4-C5, as well as uncovertebral joint hypertrophy. Extensive atherosclerotic calcifications are noted in the carotid and vertebral arteries.
1. No acute intercranial hemorrhage. 2. Likely small vessel ischemic disease of indeterminate age. 3. Left frontal hyperdensity likely corresponds to the cavernous malformation seen on the prior MRI.4. No fracture or malalignment is identified. If clinical concern for ligamentous or cord injury, MRI may be obtained for further evaluation.5. Degenerative changes of the cervical spine as above. 