5 months after the initial ENT consult, while in the nearby city for vestibular physical therapy, the patient turned his head quickly and fell.  He broke his nose, and was seen in the emergency room where CT scans were obtained.

Unenhanced CT test results:  Ventricular and sulcal prominence is consistent with cerebral and cerebellar atrophy changes.  Vascular calcification are seen at the base of the skull.  There is no acute hemorrhage, mass effect or midline shift. The basal cisterns are well visualized.  White matter changes are stable.

• Are the vascular changes consistent with suspected vascular insufficiency?  To what degree will a CT without contrast inform about blood flow?

On ENT follow up, the patient is referred to Johns Hopkins.