Differential Diagnosis
- Single most likely diagnosis
- Age-related cerebral atrophy: The prominent basal cisterns, C.P. angle, sulcal spaces, bilateral sylvian fissures, and IHF, along with the lack of mass effect or midline shift, are consistent with age-related cerebral atrophy. The presence of a lacunar infarct in the right insular cortex also supports this diagnosis, as lacunar infarcts are more common in older adults.
- Other Likely diagnoses
- Normal pressure hydrocephalus (NPH): The prominent third and lateral ventricles, along with the prominent basal cisterns and C.P. angle, could suggest NPH. However, the lack of significant mass effect or midline shift makes this diagnosis less likely.
- Chronic small vessel disease: The presence of a lacunar infarct in the right insular cortex suggests chronic small vessel disease, which could be contributing to the patient's cerebral atrophy.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Obstructive hydrocephalus: Although the fourth ventricle is central in position, it is prominent, which could suggest obstructive hydrocephalus. This diagnosis would require urgent attention, as it can lead to increased intracranial pressure and brain herniation.
- Cerebral vasculitis: Although less likely, cerebral vasculitis could present with similar imaging findings, including lacunar infarcts and cerebral atrophy. This diagnosis would require prompt treatment to prevent further brain damage.
- Rare diagnoses
- Adult-onset leukodystrophy: This rare condition could present with similar imaging findings, including cerebral atrophy and prominent ventricles. However, it would typically be associated with other clinical symptoms, such as cognitive decline and motor dysfunction.
- Cerebral amyloid angiopathy: This condition could present with lacunar infarcts and cerebral atrophy, but it would typically be associated with other imaging findings, such as lobar hemorrhages or microbleeds.