Brief Answer:
CT suggests MRI of the brain may be necessary for further analysis

Detailed Answer:
Hello and many thanks for your direct inquiry. I've reviewed the uploaded images and the rest of your problem description as well as the IMPRESSION of the radiographic report.

Since you did not provide all ALL the slices of the imaging studies I cannot fully comment on what the radiologist's report says since when reading CT, MRI, or PET scans it is very important to have all the slices available. Even in the ones you've sent, not all the things mentioned in the report seem to be present. It's not that they ARE NOT THERE...it's just that the slices you chose to upload don't demonstrate them....so I just can't comment on what they look like. I can tell you that of the slices that are present, I do not see any tumors, mass lesions, fluid overloads, excess calcifications, aneurysms, or bleeds.

I would say though that given your symptoms and from what I saw in the scan slices uploaded (incomplete) as well as the manner in which the report is written that an MRI of the brain would be a very reasonable option to pursue. Also, I recommend it be done with CONTRAST XXXXXXX (get an EGFR and CREATININE first and make sure the EGFR>60. I agree that clearing doubt with an MRI is a good suggestion and having a NEUROLOGIST'S opinion is also good since your PMD obviously feels more comfortable with a specialist evaluating your symptoms of confusion plus the headaches.

Small vessel disease or White Matter disease is very commonly seen in nearly EVERYBODY to some extent or another just based upon age so that's why I say it is not generally considered important. Such areas of LOW DENSITY comes up in anybody over the age of 40-45 (just due to the aging process) or in people who have a history of HYPERTENSION, DIABETES MELLITUS, SMOKERS or anybody with a history of smoking. You can also see such white matter defects (also called demyelination) in people who who have peripheral arterial disease or atherosclerosis (hardening of the arteries in or out of the heart).

I agree with the neurology consult to the extent that it would probably be a good idea for a specialist to give you an examination if there is any suspicion your symptoms of headaches and confusion could be related to the CT findings. I would also run a number of other lab tests such as THYROID HORMONES (TSH, FT4), Vit. B12 and D levels, inflammatory markers such as as ESR and CRP, and a URINALYSIS looking for any evidence of a mild infection, dehydration, or excess spillage of glucose or protein which may lead me to look at a few other things.

Aside from those areas of low density defect the rest of the CT scan looks normal

If I've provided useful and helpful information to your questions could you do me a huge favor by CLOSING THE QUERY and be sure to include some fine words of feedback along with a 5 STAR rating if you feel so inclined? Again, many thanks for submitting your inquiry and please let me know how things turn out.

Do not forget to contact me in the future at: www.bit.ly/drdariushsaghafi for additional questions, comments, or concerns having to do with this topic or others. I'm very interested in knowing how things evolve for you- especially if you get any testing done so drop me a line please and I'm hoping all the best for you.

This query has utilized a total of 65 minutes of professional time in research, review, and synthesis for the purpose of formulating a return statement.

---