Differential Diagnosis

• Single most likely diagnosis
  • Normal variant or involutional brain changes: The findings of mild prominence of the bilateral frontal cortical sulci and symmetrical mild widening of the extra-axial space are consistent with normal aging changes or involutional brain changes, which are common in older adults.
• Other Likely diagnoses
  • Chronic subdural hematoma: The mild widening of the extra-axial space anterior to the right temporal lobe with minimal indentation on the underlying right temporal cortical sulci could be suggestive of a chronic subdural hematoma, although the absence of significant mass effect or midline shift makes this less likely.
  • Brain atrophy: The findings could also be consistent with brain atrophy, which can be due to various causes such as Alzheimer's disease, frontotemporal dementia, or other neurodegenerative disorders.
• Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
  • Subarachnoid hemorrhage or subdural hematoma: Although the imaging does not show evidence of acute hemorrhage, it is essential to consider the possibility of a subarachnoid hemorrhage or subdural hematoma, especially if the patient presents with new or worsening symptoms.
  • Meningioma or other extra-axial tumors: The mild widening of the extra-axial space could be due to a meningioma or other extra-axial tumors, which can be asymptomatic but may cause significant morbidity if left untreated.
• Rare diagnoses
  • Neurosarcoidosis: This is a rare inflammatory disease that can cause leptomeningeal enhancement and extra-axial space widening.
  • Dural lymphoma: This is a rare type of lymphoma that can cause extra-axial space widening and may be asymptomatic or present with non-specific symptoms.