77 year old female with right-sided weakness; evaluate for CVA There is no evidence of acute intracranial hemorrhage, significant mass effect/midline shift or edema. Areas of encephalomalacia are again seen in the right parietal lobe and left temporal pole appearing similar to the prior study. Basal ganglia hypodensities, likely representing lacunar infarcts, with associated ex vacuo dilatation of the lateral ventricles. Extensive confluent hypodensities are seen in the periventricular and subcortical white matter which are nonspecific, but likely represent small vessel ischemic disease of indeterminate age showing mild interval progression from the previous exam. An area of hypoattenuation appears to involve the left frontal white and possibly gray matter which is new from the previous exam and may represent a focus of previous infarction. If high clinical suspicion for acute nonhemorrhagic stroke, MRI may be performed for further evaluation.Prominence of the ventricles, sulci and basal cisterns likely representing age-related volume loss. Extensive atherosclerotic calcifications are seen in the distal internal carotid arteries and vertebro-basilar system.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.
1. No acute intracranial hemorrhage. CT is insensitive for the early diagnosis of acute nonhemorrhagic CVA. 2. New left frontal focus of hypoattenuation appears to involve the gray and white matter and may represent a previous infarct. MRI may be performed if high clinical suspicion for acute nonhemorrhagic CVA.