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CT Head Encephalomalacia, Atrophy, Lacunar infarct

FINDINGS: There is chronic right occipital lobe encephalomalacia indicative of a chronic infarct. There is modest diffuse brain parenchymal atrophy with commensurate prominence of the intra and extra-axial CSF spaces. There is a small well-defined hypodensity in the right external capsule region compatible with a chronic lacunar infarct. There is patchy confluent hypodensity in the supratentorial white matter compatible with chronic microvascular ischemic disease. There is no acute hemorrhage, brain parenchymal edema, mass effect, hydrocephalus or herniation. A large hematoma is noted along the midline soft tissues. There are atherosclerotic calcifications in the distal internal carotid and vertebral arteries. The calvarial bones are intact. Mastoid air cells and the middle ear cavities are unremarkable. There is a small retention cyst in the floor of the right maxillary sinus. The paranasal sinuses are otherwise within normal limits. When compared to the prior head CT, there is no significant change.