Diagnosis: Subdural hemorrhageClinical question: Evaluate previously seen hemorrhageSigns and Symptoms: 2 yo M with subdural hemorrhage MRI of the brainThere is diffusion restriction present along the left cuneus.There is a left subdural collections present adjacent to the left frontal, parietal and temporal lobe which includes blood products and air with air fluid level present. It measures up to 15 mm in thickness.The patient is status post left sided craniotomy. There is a drainage catheter present at the medial most aspect of the collection which is better visualized on a recent CT of the head. The posterior aspect of the intracranial portion of the catheter (17mm) is in the subdural space and the majority of the anterior aspect (88mm) is subarachnoid. The catheter is best visualized on the coronal images.There is 3mm shift of the midline towards the right.There is a thin subdural hematoma present along the posterior aspect of the falx cerebri, tentorium and adjacent to the right occipital lobe.There is diffuse enhancement along the leptomeninges.There is subgaleal fluid present along the parietal bones bilaterally.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.Cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina.At C4-5 there is no significant compromise to the spinal canal or neural foramina.At C5-6 there is no significant compromise to the spinal canal or neural foramina.At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.MRV brain:The dural venous sinuses are patent. Straight sinus, internal cerebral veins and basal veins are identified and appear patent.
1.There is a left subdural hematoma present with mass effect and midline shift. 2.The drainage catheter at the left craniotomy site is mostly subarachnoid in location.3.There is diffusion restriction present along the left cuneus suggestive of an acute infarction.4.There is a thin subdural hematoma present along the posterior aspect of the falx, tentorium and adjacent ot the right occipital lobe.5.There is diffuse leptomeningeal enhancement present which is non-specific. This could be reactive to the above findings, though would not be possible to differentiate from leptomeningeal disease such as meningitis.6.Status post left sided craniotomy with associated postoperative changes.7.No evidence for compromise to the cervical spinal cord.8.MR venogram of the brain is within normal limits