Differential Diagnosis

• Single most likely diagnosis
  • Chronic small vessel ischemic disease: This is the most likely diagnosis given the presence of chronic small vessel ischemic changes on the CT scan. The patient's age and the presence of vascular calcification in the cavernous segment of the bilateral internal carotid arteries (ICA) also support this diagnosis.
• Other Likely diagnoses
  • Normal variant or age-related changes: The accentuated cortical sulci and chronic small vessel ischemic changes could be attributed to normal aging or variations in brain anatomy.
  • Chronic hypertension: The presence of vascular calcification and chronic small vessel ischemic changes may be related to long-standing hypertension.
  • Atherosclerotic disease: The vascular calcification in the ICA suggests atherosclerotic disease, which is a common condition in older adults.
• Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
  • Subarachnoid hemorrhage or other types of hemorrhage: Although the CT scan did not show any areas of acute hemorrhage, it is essential to consider this possibility, especially if the patient presents with sudden onset of symptoms.
  • Meningitis or encephalitis: Infection or inflammation of the meninges or brain tissue could present with non-specific findings on CT scan, and it is crucial to consider these diagnoses, especially if the patient has symptoms such as fever, headache, or altered mental status.
  • Brain tumor: Although the CT scan did not show any masses or abnormal attenuation, it is essential to consider the possibility of a brain tumor, especially if the patient has symptoms such as seizures, focal neurological deficits, or personality changes.
• Rare diagnoses
  • Cerebral amyloid angiopathy: This condition is characterized by the deposition of amyloid beta peptides in the walls of small to medium-sized blood vessels in the brain, leading to chronic small vessel ischemic changes and potentially hemorrhage.
  • Moyamoya disease: This rare condition is characterized by the narrowing or occlusion of the internal carotid arteries and their branches, leading to chronic small vessel ischemic changes and potentially hemorrhage or infarction.
  • Vasculitis: Inflammation of the blood vessels in the brain could present with non-specific findings on CT scan, and it is essential to consider this possibility, especially if the patient has symptoms such as headache, fever, or focal neurological deficits.