Differential Diagnosis for CT Head Findings

Given the CT head findings of no acute hemorrhage, no acute territorial infarct, and mild chronic small ischemic changes, the following differential diagnoses are considered:

• Single Most Likely Diagnosis

  • Chronic small vessel ischemic disease: This is the most likely diagnosis given the presence of mild chronic small ischemic changes on the CT head. These changes are consistent with long-standing small vessel disease, which can result from hypertension, diabetes, or other vascular risk factors.

• Other Likely Diagnoses

  • Multi-infarct dementia: The presence of chronic small ischemic changes could also suggest a history of multiple small infarcts, which might contribute to cognitive decline or dementia.
  • Chronic cerebral vasculopathy: This could include conditions such as moyamoya disease or other non-atherosclerotic vasculopathies that lead to chronic ischemic changes.

• Do Not Miss Diagnoses

  • Vasculitis: Although less common, vasculitis (inflammation of the blood vessels) could present with similar findings and would be critical to diagnose due to its potential for severe consequences if left untreated.
  • Infectious or inflammatory conditions: Certain infections (e.g., neurosyphilis) or inflammatory conditions (e.g., multiple sclerosis) could mimic chronic ischemic changes and would have significant implications for treatment.

• Rare Diagnoses

  • CADASIL (Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy): A rare genetic disorder that affects the blood vessels in the brain, leading to subcortical strokes and dementia.
  • Mitochondrial disorders: Certain mitochondrial disorders can affect the brain and lead to chronic ischemic-like changes due to impaired energy production.