79 year old female with metastatic breast cancer to bone. CVA with left hemiparesis. Hydronephrosis in the past and a stage IV decubitus ulcer presenting with altered mental status. Nonenhanced head CT:Examination demonstrate no evidence of gross intracranial metastatic disease. To entirely exclude possibility of metastatic lesions enhanced MRI or CT exam is recommended. Finding highly suspected of advanced small vessel disease of indeterminate age are noted.There is no evidence of hemorrhage, edema, mass effect, midline shift or hydrocephalus.Multiple poorly defined lytic bony changes with no definitive evidence of breakthrough of cortex are suspected for metastatic lesions.
1.Limited value examination for metastatic disease due to lack of intravenous contrast. No gross evidence of metastases no disease to the brain. Small osseous lytic skull metastases.2.Small vessel disease of indeterminate age.