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CT Head Early MCA Stroke

Findings: There is sulcal effacement and subtle obscuration of the gray-white interface along the right hemisphere, in the expected territory of the middle cerebral artery. There is no asymmetry of the CSF spaces, hydrocephalus or herniation. There is no increased attenuation in the visualized portions of the proximal middle cerebral arteries. The remainder of the brain parenchyma is normal in density, size and configuration.

There is no hemorrhage, pathologic fluid collection, hydrocephalus or herniation. The calvarium is intact. The orbits, mastoid air cells and bilateral temporomandibular joints are unremarkable. The paranasal sinuses are clear. The demonstrated soft tissues are unremarkable.

Impression: Apparent sulcal effacement and subtle obscuration of the gray-white interface along the expected territory of the right middle cerebral artery. These findings may be seen with early cerebral ischemia and/or edema. Alternatively, this may be due to a migrational disorder such as cortical dysplasia or less likely cortical neoplasm. Close correlation with neurological exam is recommended. Given recent IV contrast load and elevated creatinine, the use of CT angiography must be weighed against the potential risk of contrast induced nephropathy.
Findings: There is subtle sulcal effacement and loss of gray-white differentiation in the right MCA distribution predominantly involving the right frontal lobe, suspicious for an acute infarct. There is no evidence of significant mass effect/ midline shift, hydrocephalus, herniation, or intracranial hemorrhage. The CSF-containing spaces appear unremarkable for age. Scattered periventricular hypodensities remain, compatible small vessel ischemic changes.

The demonstrated calvarial bones are intact. Bilateral lens replacement are again noted. The mastoid air cells and paranasal sinuses are clear.

Impression: Findings are suspicious for an acute infarct in the right MCA distribution without evidence of intracranial hemorrhage or herniation.