75 year-old female with altered mental status and lethargy. Evaluate for ICH or mass. There is no evidence of intracranial hemorrhage, mass or edema. Multifocal areas of patchy hypoattenuation in the subcortical and deep white matter distribution, nonspecific, however most likely related to small vessel ischemic disease, age indeterminate. No evidence of acute cortical stroke is noted. If there is clinical concern for acute ischemia, an MRI may be considered.The ventricles and basal cisterns appear enlarged secondary to volume loss.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.
1. Multifocal white matter hypoattenuation most likely representing small vessel ischemic disease, age indeterminate. 2. No evidence of acute cortical stroke. If there is clinical concern for acute ischemia, MRI may be considered.3. No evidence of mass or intracranial hemorrhage as clinically questioned.