Patient with two days history of headaches with frontal neurologic signs, vertigo, sensory deficit, bilateral hand tingling, right cranial nerves 6 palsy, vertical nystagmus. CT of brain without and with infusion:No evidence of hemorrhage, edema, mass effect, midline shift or hydrocephalus.Subtle foci of low-attenuation in the periventricular white matter of bilateral hemispheres are not specific and non-enhancing. The findings considering patient's age are concerning for demyelinating disease. Possibility of stroke cannot be entirely ruled out. Follow up with a dedicated MRI of brain is recommended. There is no evidence of parenchyma volume loss. Cortical sulci and ventricular system remain within normal. No evidence of any abnormality of cortex is detected.On post infusion images no abnormal enhancement of brain parenchyma or leptomeninges is detected.Calvarium is intact. Mastoid air cells and limited view of paranasal sinuses are unremarkable.100 cc of Omnipaque 350 was utilized for the above study.
1.Periventricular foci of low attenuation without enhancement is concerning for demyelinating disease considering patient's age. Ischemic stroke or other etiologies cannot be entirely ruled out and further follow-up with an MRI is recommended.2.There is no abnormal enhancement on post infusion images.3.Calvarium, paranasal sinuses and mastoid air cells are unremarkable.