Differential Diagnosis
- Single most likely diagnosis
- Chronic small vessel ischemic disease: This is the most likely diagnosis given the presence of mild chronic small vessel ischemic changes on the imaging study. The patient's symptoms and history are not provided, but the imaging findings suggest a chronic process rather than an acute event.
- Other Likely diagnoses
- Normal pressure hydrocephalus (NPH): The prominent bilateral frontal cortical sulci could be indicative of NPH, especially if the patient has symptoms such as gait disturbance, dementia, and urinary incontinence.
- Brain atrophy: The prominent bilateral frontal cortical sulci could also be due to brain atrophy, which can be a normal part of aging or related to various neurodegenerative diseases.
- Chronic subdural hematoma: Although there is no evidence of acute hemorrhage, a chronic subdural hematoma could be present and not visible on the imaging study, especially if it is small or isointense to the brain parenchyma.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Subarachnoid hemorrhage: Although there is no evidence of acute hemorrhage, a subarachnoid hemorrhage could be present and not visible on the imaging study, especially if it is small or has been partially cleared.
- Cerebral venous sinus thrombosis: This condition can present with non-specific symptoms and imaging findings, and can be deadly if not promptly diagnosed and treated.
- Meningitis or encephalitis: These conditions can present with non-specific symptoms and imaging findings, and can be deadly if not promptly diagnosed and treated.
- Rare diagnoses
- CADASIL (Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy): This is a rare genetic disorder that can present with chronic small vessel ischemic changes and prominent cortical sulci.
- Fabry disease: This is a rare genetic disorder that can present with chronic small vessel ischemic changes and prominent cortical sulci, as well as other systemic symptoms.