Clinical question: Assess for intracranial hemorrhage. Signs and symptoms: Altered mental status status post concussion two months ago with CLL and thrombocytopenia Nonenhanced CT of brain:There is no it is of intracranial hemorrhage, edema, mass-effect, midline shift or hydrocephalus. A very subtle area of low attenuation in the right basal ganglia at the level of genu of internal capsule may represent a lacunar infarct of indeterminate age. Please correlate with history and if needed follow-up with an MRI is recommended for detection of acute lacunar infarct.Cortical sulci, ventricular system and all CSF cisterns remain within normal for patient stated age of 77.There is also a small extra-axial collection of CSF density which measures approximately 36 mm in AP axis and 12-mm in thickness at the level of sylvian fissure on the left. This is associated with subtle bony remodeling of calvarium. This finding is believed to represent a small arachnoid cyst and is best appreciated on axial images 15 through 17.
1.Small low-attenuation in the genuine of right internal capsule may represent a small lacunar infarct of indeterminate age. Please correlate with history and follow-up with an MRI.2.Small extra-axial left temporal arachnoid cyst as detailed.3.Unremarkable CT examination of brain otherwise.