Differential Diagnosis
- Single most likely diagnosis
- Chronic small vessel ischemic disease: This is the most likely diagnosis given the presence of confluent and non-confluent hypodensities in the periventricular and subcortical white matter, which are characteristic of chronic small vessel ischemic changes. The presence of focal hypodensities in the left centrum semiovale and pons, which could represent chronic lacunar infarcts, further supports this diagnosis.
- Other Likely diagnoses
- Multi-infarct dementia: The presence of multiple chronic lacunar infarcts and white matter changes could contribute to cognitive decline and dementia.
- Normal pressure hydrocephalus: The mild prominence of the lateral ventricles and prominent cortical sulci could be suggestive of normal pressure hydrocephalus, although this would require further evaluation.
- Chronic sinusitis: The mucosal thickening in the right sphenoid and maxillary sinuses could represent chronic sinusitis.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Lymphoma: The 9.3 mm isodensity seen in the subcutaneous soft tissue of the right suboccipital region could represent lymphoma, which would require prompt evaluation and treatment.
- Meningioma: Although not directly suggested by the imaging findings, a meningioma could present with similar white matter changes and should be considered in the differential diagnosis.
- Rare diagnoses
- CADASIL (Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy): This rare genetic disorder could present with similar white matter changes and lacunar infarcts.
- Susac syndrome: This rare autoimmune disorder could present with similar white matter changes and should be considered in the differential diagnosis, although it is much less likely.