clinical question: Patient with decreased mental status and with new right facial droop. Signs and symptoms: Right facial droop. Nonenhanced head CT:Extensive small vessel disease as was noted on prior MRI exam is again identified. The age of a small was ischemic strokes cannot be determined on CT.Also as was noted on prior exam an old large right frontal MCA territory cortical stroke shows no interval change. Prominence of cortical sulci and ventricular system are believed to be at least partially secondary to underlying parenchymal volume loss secondary to old ischemic strokes.No evidence of hemorrhage, mass effect or midline shift or hydrocephalus.Head CT is not sensitive for detection of any acute strokes.Calvarium is intact. There is evidence of an old left orbital blowout fracture of the floor and the lamina papyracea as was noted on prior exam.
1.Advanced to small vessel is of indeterminate age.2.Old right MCA frontal lobe cortical stroke as was noted on prior exam.3.No evidence of hemorrhage, mass-effect or midline shift. 