What does this CT scan of brain indicate?
Type: CT HEAD WITHOUT CONTRAST
INDICATION: Altered mental status.
TECHNIQUE: Noncontrast 5 mm CT axial images were performed from the skull base through the vertex, and reformatted into coronal and sagittal planes.
COMPARISON: Maxillofacial CT 5/15/2015.
FINDINGS: There is an ill-defined hypodense area within the right insular region (2: 17) that is not definitely seen on the
maxillofacial CT from 5/15/2015. There is no midline shift, mass effect or hemorrhage. There is prominence of the ventricles and sulci, likely related to atrophy. There is no significant soft tissue swelling or calvarial fracture. There is mucosal thickening of the ethmoid air cells and the left maxillary sinus. There is partial opacification of the mastoid air cells bilaterally.
IMPRESSION: Ill-defined area of hypodensity within the right insular region not definitely seen on recent maxillofacial CT. Brain MRI is recommended for further evaluation.
HERES THE ONE FROM 5/7:
Type: CT SCAN HEAD W/O CONTRAST
No mass, midline shift, hemorrhage, extraxial fluid collection, or CT evidence of evolved territorial infarct.
The ventricles, cisterns, and sulci are mildly enlarged for the patient's age.
Mild periventricular white matter disease is noted. Rounded hypodensity in the posterior limb of the right internal capsule. (5:18) is not significantly changed.
There has been interval worsening opacification of the left frontal sinus with associated air-fluid level and of the left sphenoid sinus with associated air-fluid level. Multiple anterior
and posterior ethmoid air cells are also partially opacified. Opacification of the bilateral mastoid air cells and left middle ear is not significantly changed.
1. Slight interval worsening sinus disease with air-fluid levels in the left frontal and left sphenoid sinuses with unchanged fluid in the mastoid air cells and left middle ear opacification suggest the possibility of sinusitis and/or otitis. Clinical correlation recommended.
2. Unchanged mild involution and mild nonspecific white matter disease, likely related to microvascular ischemia in this age group.
3. No intracranial hemorrhage or other acute intracranial abnormality.
CT can't identify the type of lesion.
I read both those CT scans carefully and I understand your concern.
The new CT scan in terms of the brain differs because there is a new finding in the insular region. The insula is a brain lobe, the smallest one. While it takes less than 2% of the cerebral cortex it is involved in many different complex circuits in the brain dealing with language, processing of emotions, pain etc, so the symptoms can be variable, at times subtle and hard to identify, mostly related to changes in emotional expression and language.
Regarding the prognosis unfortunately that is a question which can not be answered. That is because the CT scan (furthermore without contrast) is unable to identify the nature of that finding, the radiologist recommends a MRI to do that. It could be a stroke, tumor or infection which can all affect the brain and have a hypodense appearance. A MRI uses several techniques, called sequences to obtain images and according to the combination of the look of that area on different sequences it is easier to differentiate its type. The prognosis naturally would vary according to the type of lesion.
As for the microvascular ischemic changes those should not cause any major symptoms for now, but call for attention towards vascular risk factors in order for them not to advance. By vascular risk factors I mean if present high blood pressure, diabetes, smoking, high cholesterol, obesity etc. There is also sinusitis and otitis in the first scan which might have been already treated with antibiotics.
I remain at your disposal for further questions.
Those lesions do not justify his condition
Thank you for bringing some more info.
Comparing that description with the imaging data I must say that they do not justify his condition. He could have some mild numbness or weakness of his right limbs, speech issues as well, but he should be alert, able to eat and drink, have some movements of his limbs, that overall condition you describe doesn't correspond at to those scans, especially if his condition was like that from the first scan.
If his symptoms developed in a sudden manner a stroke is the most likely cause followed by infection, tumor is less likely.
I suppose some routine blood tests have been done to exclude metabolic causes like glucose or electrolyte alterations, liver or kidney failure etc. Blood count should give some indication for infection as well.
Unless another such explanation is found he should have MRI by all means. Apart from being able to differentiate lesions the way I mentioned above, MRI can at times detect lesions which have been missed by CT like in the posterior areas of the brain.
I hope things work out for the best.
I read that report. It's not a term that we use commonly (I guess language differences) but I think that by second state they mean that the state of the patient remained the same, in a prolonged EEG there are recordings during sleep where there can be some specific sleep related phenomena. Anyway that EEG shows just encephalopathy, general alteration in brain function but doesn't indicate the cause. I wouldn't expect it to either, but it's good it has been done as in some cases it reveals some specific changes, not in this case.
In terms of correlating to CT abnormalities, no, it confirms that there is more to his condition than those two small hypo-densities on the CT scan.
Hopefully the MRI will shed some more light.
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