Severe headache. History of intractable epilepsy and brain cysts. 27 year old female with, cerebral palsy, encephalitis, post hemispherectomy as child, hydrocephalus with VP shunt and multiple revisions. Previous craniotomy for cyst fenestration and removal of Ommaya reservoir and intracranial catheter. There are findings related to previous right cerebral hemispherectomy. The multiloculated cystic structure at the resection margin which also involves the posterior aspect of the left cerebral hemisphere has slightly increased since the previous examination. The largest locule that along the posterior body/splenium of the corpus callosum now measures in the axial plane 3.4 cm x 2.7 cm (image #19 of series #501) compared to 2.3 cm x 2.2 cm (image #13 of series #7). These locules are now entirely fluid-filled with no air and have similar signal intensity to CSF with complete attenuation on FLAIR sequence.The moderate periventricular T2-hyperintensity in the left cerebral hemisphere and along the resection margin has not changed and may reflect gliosis. The tracts of the previous left parieto-occipital ventriculostomies and the associated susceptibility artifact remain unchanged. The left lateral ventricle remains collapsed except for its temporal horn. There is no diffusion restriction in the brain parenchyma. Apparent tethering of the upper cervical spinal cord to the posterior dura at the site of previous posterior decompression is unchanged, with mild associated kinking.The multiloculated fluid collection just deep to the partially resorbed right pterional craniotomy flap is not significantly changed in size with resolution of previously seen air. It shows diffusion restriction which most likely reflect the presence of blood products.The right internal carotid artery and its right anterior and middle cerebral arteries are small in size but show preserved flow voids. The other major intracranial arteries show also preserved flow voids, reflect gross patency.
1.Compared to the previous MRI from September 2015, the multiloculated cystic structure at the right hemispherectomy margin and involving the corpus callosum is slightly increased in size although results in no significant mass-effect.2.The air within this multiloculated cystic structure and in the extra-axial fluid collection at the craniotomy site is resolved and the cysts are now completely fluid-filled.