Clinical question: evaluate edema, stroke, include sinuses. Signs and symptoms: Meningitis, CVAs Nonenhanced CT of brain:Multiple previously noted left hemispheric subacute cortical and left basal ganglial nonhemorrhagic strokes are again identified. There is no appreciable interval change. Mass-effect and effacement of cortical sulci is again identified. No change in the degree of mass effect.There is a very subtle area of low attenuation in the cingulate gyrus of the right posterior frontal which was not appreciated on prior CT study however it was present on prior MRI examination. There is also better visualization of a single small foci of low-attenuation in the right anterior limb of internal capsule which was also present on prior MRI however not on head CT.There is no evidence of interval hemorrhage or new ischemic stroke.CT of paranasal sinuses:There is fluid level within the dependent portion of bilateral maxillary sinuses. The ostiomeatal units of maxillary sinuses are patent. There is very extensive opacification of sphenoid sinus with mucosal thickening as well as fluid no. Extensive opacification of left posterior ethmoid air cells and to a lesser degree all the other ethmoid air cells. Frontal sinuses are pneumatized and no images of pathology. Presence of NG tube could explain presence of fluid within the sinuses.Images through nasal cavity demonstrate NG tube and some mucosal thickening. There is also partial opacification of bilateral mastoid air cells however with no opacification of the cavities.
1.Revisualization of multiple left hemispheric and few small right hemispheric ischemic strokes with no areas of hemorrhagic conversion and no evidence of new stroke. The mass-effect remains identical to prior study.2.Extensive because of thickening and fluid levels within paranasal sinuses could be result of patient's NG tube placement or sinusitis.3.The ostiomeatal units of maxillary sinuses are patent bilaterally.