Is a computed tomography (CT) scan of the head normal, given the absence of intracranial hemorrhage, mass, infarct, or midline shift, with preserved gray-white differentiation and normal ventricles?

From the Guidelines

The patient's CT head scan is completely normal, with no evidence of intracranial hemorrhage, mass, infarct, or mass effect, and therefore, no further immediate medical intervention is required. The scan shows preserved gray-white differentiation, normal ventricles and basal cisterns, and intact calvaria and skull base, which are all indicative of a healthy brain structure 1. The presence of a retention cyst or mucosal polyps in the sphenoid sinus is an incidental finding that is unchanged from a previous CT scan and typically does not require treatment. The sella turcica is of normal caliber, which suggests that the pituitary gland is likely functioning properly.

Some key points to consider in this case include:

• The CT scan is sensitive enough to detect possible complications of intracranial pathology, such as progressive mass effect, increasing edema, hydrocephalus, new or enlarging intracranial hemorrhage (ICH), and progressive ischemia 1.
• The advantages of CT scans, such as fast examination times and less susceptibility to motion artifact compared to MRI, make them a useful tool in the emergent setting 1.
• However, it is also important to note that CT scans may have disadvantages, such as less sensitivity in detection of acute ischemia and enhancement compared to MRI 1.

Given the completely normal findings on the CT scan, no further imaging or medical intervention is required at this time, and the patient can be reassured that there are no abnormalities that would require immediate medical attention 1.

From the Research

CT Head Findings

• The brain parenchyma demonstrates no focal finding, with no intracranial hemorrhage, mass, or infarct 2.
• There is no mass effect or midline shift, and the gray-white differentiation is preserved.
• The ventricles and basal cisterns are normal in caliber.
• The calvaria and skull base are intact, with no aggressive bone lesion.

Sphenoid Sinus Findings

• A retention cyst/mucosal polyps in the sphenoid sinus is noted, similar to a previous CT performed on April 9,2025.
• Sphenoid sinus mucous cysts are rare, benign, expansile masses that can form mucoceles if the entire sinus is filled 3.
• The incidence of sphenoid sinus cysts has apparently increased in recent years, with the most common symptom being headache 4.
• Sphenoid sinusitis is uncommon, with an incidence of about 2.7%, and can lead to serious neurologic sequellae if left untreated 5.

Diagnostic Imaging

• CT scans can provide a positive diagnosis of sphenoid sinus disease by visualizing mucosal thickening, air-fluid level, and complete opacification of the sinusal cavities 5.
• MRI can be used in cases of suspected tumors or neurologic involvement 5.
• Nasal endoscopy can provide more information to establish a correct diagnosis and guide management, with operation under nasal endoscope being a safe and effective treatment option 4.
• Contiguous axial or coronal magnetic resonance and CT images can help differentiate between sphenochoanal polyps and antrochoanal polyps 6.