59-year-old female with 3 day history of headache and now has altered mental status. Evaluate for bleed. Patchy nonspecific areas of low attenuation are seen in periventricular white matter with a more discrete focus seen in the right thalamus as well as vague hypoattenuation in the left pons. While these may represent sequela from small vessel ischemic disease, they are of indeterminate age and acute infarct cannot be excluded. If acute infarct is suspected, an MRI should be considered.There is no evidence of intracranial hemorrhage, mass or edema. The ventricles and basal cisterns are normal in size and configuration.High density material in the left globe may represent a dislodged lens.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.
Patchy, nonspecific areas of low-attenuation in the periventricular white matter with a more discrete focus seen in the right thalamus and vague hypoattenuation in the left pons. Without prior comparison studies, it is difficult to distinguish between sequela from small vessel ischemic disease from acute infarct. If acute stroke is clinically suspected, an MRI should be considered.Findings were discussed with the MICU service (pager 3577) via telephone at the time of dictation.