Postoperative evaluation of his subdural and epidural empyema andcraniectomy. There is increased depression of the scalp by up to approximately 4 cm through the left frontoparietal craniectomy defect associated with compression of the underlying brain parenchyma and 8 mm of midline shift to the right, as well as partial effacement of the left lateral ventricle. There is persistent diffuse dural thickening and enhancement involving the left cerebral convexity, and to a lesser extent right anterior cerebral convexity. There is a 3 mm wide left cerebral convexity nonenhancing area within the thickened dura anterior to the craniectomy defect. There is also persistent prominent left cerebral hemisphere pial vascularity. There are subcentimeter defects in the right pons, bilateral basal ganglia, and right corona radiata, which likely represent chronic infarcts. There are also patchy areas of cerebral white matter T2 hyperintensity. There is no evidence of acute infarction.
1. Increased sunken scalp through the left frontoparietal craniectomy defect associated with compression of the underlying brain parenchyma and 8 mm of midline shift to the right.2. Persistent diffuse dural thickening and enhancement involving the left cerebral convexity, and to a lesser extent right anterior cerebral convexity with what appears to be a nonspecific 3 mm wide left cerebral convexity subdural collection anterior to the craniectomy defect, which may represent a residual hematoma, although superimposed infection cannot be excluded.