Differential Diagnosis
- Single most likely diagnosis
- Small vessel disease (chronic lacunar infarcts): The presence of confluent and non-confluent hypodensities in the periventricular and subcortical white matter, along with focal hypodensity in the left centrum semiovale and pons, suggests chronic lacunar infarcts, which are characteristic of small vessel disease.
- Other Likely diagnoses
- Chronic microvascular ischemic changes: These changes are often seen in the context of hypertension, diabetes, or other vascular risk factors, and can lead to the development of white matter hyperintensities and lacunar infarcts.
- Leukoaraiosis: This condition is characterized by the presence of white matter hyperintensities on imaging, often associated with aging, hypertension, and small vessel disease.
- Normal pressure hydrocephalus (NPH): The mild prominence of the lateral ventricles and prominent cortical sulci could suggest NPH, although the absence of significant midline shift and other characteristic features makes this less likely.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Lymphoma: The 9.3 mm partially visualized isodensity in the subcutaneous soft tissue of the right suboccipital region could represent lymphoma, which would require prompt evaluation and treatment.
- Meningioma or other intracranial tumors: Although not directly suggested by the imaging findings, it is essential to consider the possibility of intracranial tumors, which could have significant implications for patient management.
- Rare diagnoses
- CADASIL (Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy): This rare genetic disorder is characterized by recurrent subcortical infarcts and leukoencephalopathy, which could be considered in the differential diagnosis, although it is relatively uncommon.
- Mitochondrial encephalopathy, lactic acidosis, and stroke-like episodes (MELAS): This rare mitochondrial disorder can present with stroke-like episodes and leukoencephalopathy, although it is typically associated with other systemic features and would be an uncommon consideration in this case.