Patient History
Cluster headache, not intractable, unspecified chronicity pattern.
Findings
Non-contrast CT head:
These images show abnormal hypoattenuation involving the right anterior insula, right lentiform nucleus and head of the right caudate nucleus, as well as the right frontal operculum with cortical involvement and loss of gray-white distinction with sulcal effacement involving the right frontoparietal brain as well as the right inferior frontal gyrus. Smaller focus of involvement of the posterior insula is contiguous with hypoattenuation in the right frontoparietal operculum. Subcortical focus of encephalomalacia is seen involving the postcentral gyrus.There is mild extrinsic impression upon the right frontal horn. Otherwise no shift of midline structures is noted. No evidence of hemorrhagic transformation is seen. No evidence of acute intracranial hemorrhage or extra-axial fluid collection present.
There is slightly increased density of the right middle cerebral artery, with punctate hyperdensity involving a branch vessel of the posterior portion of the sylvian fissure. Basal cisterns are patent. No focal abnormality seen in the posterior fossa. Atherosclerotic calcifications are present within the vertebral arteries as well as the right greater than left cavernous carotids.
Impressions
1. These images demonstrate multiple areas of hypoattenuation and loss of gray-white distinction involving the right frontal lobe and the right-sided basal ganglia as well as the right insula, consistent with acute infarctions involving the right MCA distribution.
2. Mildly hyperdense appearance of the right middle cerebral artery as well as a posterior branch compatible with clots.
3. Focus of encephalomalacia seen in the right postcentral gyrus that may represent a focus of chronic ischemia.
