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CT Head Encephalomalacia

FINDINGS: Right temporal and occipital lobe encephalomalacia is visualized compatible with history of prior right MCA and PCA territory infarcts, with the right temporal infarct occurring since the study from 2008. There is also a chronic appearing, well marginated left basal ganglia lacunar infarct since comparison study. Mild diffuse periventricular white matter hypodensity compatible with chronic small vessel ischemic change. There has been interval progression mild diffuse brain parenchymal atrophy with mild prominence of the CSF-containing spaces is likely secondary to atrophy. No hemorrhage, mass effect, or herniation. Atherosclerotic calcifications in the distal internal carotid and vertebral arteries. No calvarial lesions.

1. No CT evidence of acute intracranial pathology.
2. Right temporal and occipital lobe encephalomalacia compatible with old right MCA and PCA territory infarct; right temporal has occurred since 2008.
3. Chronic appearing small lacunar infarct in left basal ganglia since 2008.
4. Chronic mild ventriculomegaly and brain parenchymal atrophy worse since 2008.
Findings: There is no hemorrhage, edema, pathologic fluid collection, hydrocephalus, mass effect or herniation. A focal area of encephalomalacia extends from the anterior aspect of the right pons posteriorly and measures 13 x 7 x 4 mm (series ...). There is diffuse periventricular white matter hypodensity compatible with chronic microvascular ischemic disease. There is otherwise normal configuration throughout the brain parenchyma and CSF spaces.The calvarium is intact. The orbits, mastoid air cells and bilateral temporomandibular joints are unremarkable. The paranasal sinuses are predominantly clear. Mild polypoid mucosal thickening is noted in nasal cavities. The demonstrated soft tissues are unremarkable.

1. Focal encephalomalacia of the right pons is consistent with prior infarct. Correlate with the prior studies physical exam findings.
2. Other senescent changes without additional evidence of acute intracranial pathology.

It should be noted that acute infarct may be normal on the initial head CT. If there is continued concern for infarct, recommend repeat head CT in 12-24 hours versus MRI.
Findings: There is a hypodensity involving the right posterior frontal and anterior parietal gray and white matter. The majority of the lesion has density similar to CSF and is likely related to chronic infarct. Questionable associated subacute component versus associated gliosis is noted at the posterior medial margin. Followup CT versus MR could be performed as deemed clinically appropriate.

An additional subcentimeter hypodensity is noted in the right superior cerebellum which may represent an old infarct, dilated extra axial CSF space versus a small arachnoid cyst. There is otherwise no intracranial mass, midline shift, acute hemorrhage, hydrocephalus, or pathologic extra-axial fluid collection.

An enteric tube is partially partially visualized in the nasal cavity and oropharynx. Calcifications are noted in the bilateral carotid arteries. Degenerative changes are seen at the predental space. Scattered polypoid mucosal thickening is noted in the paranasal sinuses. The visualized orbits and calvarium are unremarkable.

1. Findings compatible with prior right MCA distribution infarct, possibly related to acute on chronic infarcts. See comments above. Comparison with prior studies is suggested. If prior studies not available for comparison, followup CT or MRI can be performed.
2. Right cerebellar hypodensity and other senescent changes as described in detail above.