Clinical question: evaluate for intracranial process, metastases. Signs and symptoms: Altered mental status, metastatic disease or joint cancer. Non-enhanced CT of brain:Examination demonstrates no evidence of intracranial hemorrhage, edema, mass-effect, midline shift or hydrocephalus. There is revisualization of nonspecific periventricular and subcortical white matter patchy area of low-attenuation that are believed to represent small vessel disease. These findings were present on prior exam and demonstrate no gross interval change. No evidence of metastatic lesion to the brain on this non-infusion study. Lack of intravenous contrast enhancement significantly reduces the sensitivity of this exam for detection of small metastatic lesions. Follow up with an enhanced study or an MRI is recommended.Calvarium is intact. Limited images of orbits are unremarkable. Mastoid air cells and limited real paranasal sinuses are unremarkable.
1.Findings consistent with small vessel disease of indeterminate age and with no gross interval change since prior exam.2.Enhanced examination will significantly increase the sensitivity of the test for detection of metastatic lesions. This non-infused study demonstrate no large metastatic lesions.3.Calvarium, paranasal sinuses and mastoid air cells are unremarkable.