Clinical question: altered mental status. Signs and symptoms: Nonenhanced head CT:Technique.Axial 5 mm CT images of the head without administration of contrast is obtained. Sagittal and coronal 2-D reformatted images rendered.There is paucity of cortical sulci, small supratentorial ventricular system and in the CSF cisterns. Although this finding may be well within normal for patient stated age of 19 possibility of subtle increase intracranial pressure/edema cannot be entirely ruled out. The gray -- white matter differentiation remains well within normal. Images through posterior fossa demonstrate crowding of the cerebellar tonsils which is suspected for Chiari malformation. This finding is best appreciated on sagittal reformatted images in particular on number 26. Recommend follow-up with an MRI examination.There is no evidence of hemorrhage or midline shift.
1.Ectopia of cerebellar tonsils evident by crowding of the foramen magnum. Recommend follow-up with an MRI exam.2.No definitive evidence of density abnormality of brain parenchymal or morphologic abnormality. Paucity of cortical sulci and the small size of ventricular system and CSF cisterns are noted which could still be within normal range for patient stated age of 18. Subtle intimal may present with this appearance.