93 year-old female with left-sided facial droop and left-sided weakness. Evaluate for CVA. There is no acute intracranial hemorrhage, mass effect or basal cistern effacement. There is no CT evidence of acute territorial ischemia. However, there are multiple ill-defined areas of hypoattenuation in the periventricular and deep white matter bilaterally. In a patient of this age, these findings may represent chronic small vessel ischemic disease, however, an acute infarct cannot be completely excluded. MRI can definitively exclude ischemic insult if there is high clinical suspicion for infarct.The ventricles and basal cisterns are normal in size and configuration. . There is no extra-axial fluid collection. Expected moderate volume loss for age.The calvaria and skull base are radiographically normal. There is mild mucosal thickening of the left sphenoid sinus. There are mild atherosclerotic changes of the intradural vertebral arteries. Incidental note is made of bilateral lens prosthesis.
No CT evidence of acute territorial ischemia or acute intracranial hemorrhage.Mild ill-defined periventricular and deep white matter hypoattenuation. In a patient of this age, these findings may represent chronic small vessel ischemic disease. MRI can more definitively exclude acute or small infarcts.