92 year-old female with altered mental status, respiratory distress. Rule out CVA. Multiple areas of subcortical and periventricular white matter hypodensity likely represent extensive small vessel ischemic disease, age indeterminate by CT. This appears to have progressed slightly since the prior examination. There is worsening of white matter hypodensity in the left frontal convexity, particularly along the superior frontal gyrus. Abnormal areas of attenuation are also noted in the cerebellar hemispheres appear worse compared to the prior examination. If there is concern for an acute stroke, an MRI is recommended for further evaluation. There is no evidence of intracranial hemorrhage or mass. Prominence of the ventricles and sulci indicate moderate to severe corticomedullary volume loss.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.
Extensive small vessel ischemic disease, age indeterminant, but with slight progression compared to the prior examination. If there is concern for acute stroke on an MRI is recommended for further evaluation.