50 year-old woman with right hemiparesis. Status post recent aneurysm coiling, remote history of intracranial hemorrhage. Evaluate for ICH / stroke. There is no evidence of acute intracranial hemorrhage, mass or edema. There are midline metallic densities consistent patient's known history of aneurysm coiling. There are periventricular hypodensities which are more pronounced on the left as well as focal regions of hypodensity in the subcortical regions and basal ganglia bilaterally. These findings are consistent with age-indeterminate small vessel ischemic disease and lacunar strokes, respectively. Areas of encephalomalacia are present in the distribution of the bilateral anterior cerebral arteries (series 5 image 24) consistent with prior stroke. There are no definite CT findings of acute stroke. However, if acute stroke remains clinical concern recommend MRI.The left lateral ventricle is larger than the right. There is a shunt which enters through the frontal bone to the right of the midline and terminates in the region of the third ventricle. There is a region of encephalomalacia adjacent to the shunt.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.
1. No CT findings of acute intracranial hemorrhage.2. No definite CT findings of acute stroke. If stroke remains clinical concern, recommend further evaluation with MRI.3. Metallic densities consistent with prior aneurysm coiling and ventricular shunt with adjacent encephalomalacia.4. Age-indeterminate findings of small vessel ischemic disease.5. Midline frontal and parietal regions of encephalomalacia consistent with prior stroke in bilateral ACA distribution.