 BRAIN MRI:There is bilateral predominantly parietal subdural hemorrhages with mixed hyper and isointense signal on T1-weighted images and associated septations and strong susceptibility artifact. These collections produce mass effect with effacement of the sulci. There is no evidence of brain herniation. The widest thickness of the collection measures 15 mm on the right and 13 mm on the left. The dura overlying the collections is thickened and enhancing, which extends to involve almost the entire cerebral dura on the left and somewhat less so on the right. On postcontrast images, there is a suggestion of contrast permeation into the collections.Since the prior examination, substantial periventricular white matter volume loss has occurred giving the false impression of improvement in the degree of both periventricular T2 signal abnormality and the previously seen, biopsy proven benign periventricular enhancement. A 4 mm focus of enhancement is seen within the right insula, which is new compared to the previous study.High signal seen in the peripheral right frontal bone due to biopsy related burr hole.Normal flow voids of the visualized internal carotid arteries and of the cerebral arteries.PITUITARY MRI:The pituitary gland is normal in enhancement and in size. No evidence of pituitary adenoma or distinct mass.
1. Bilateral subdural hematomas with mixed intensities, suggestive of a combination of older and newer blood product.2. Diffuse dural enhancement, likely reactive to the the subdural hematomas. 3. Substantial periventricular white matter volume loss giving the false impression of improving T2 signal and enhancement in the periventricular regions. 4. A new 4 mm focus of enhancement in the right insula is nonspecific. Follow-up is suggested.5. Normal pituitary evaluation.