 Evaluation is limited due to lack of coronal T2-weighted images, and axial T2-weighted images are not of usual FSE technique. 3-D SPGR images are degraded by artifact. Axial T1 inversion recovery images are also not available to aid with myelination evaluation.There are numerous scattered foci of susceptibility, slightly more tubular in appearance along the right parietal lobe near the convexity, possibly representing hemosiderin deposition along the gray-white junction. Additional punctate foci are seen along the left anterior mid frontal lobe, the right anterior temporal lobe, the right greater than left occipital lobe, along the left greater than right tentorium, as well as near the cerebellar tonsils, perhaps along the fourth ventricular outflow on the left side. These are predominantly peripheral in location, possibly at the gray-white junction. The most conspicuous area of abnormal susceptibility is seen along the anterior left temporal lobe which may be subarachnoid in location given its plaque-like configuration. The right occipital lobe finding may involve the peripheral cortex, with possible foci in the adjacent extraparenchymal space.On axial T2-weighted images, there is prominence of extra-axial space along the frontal lobes with no significant traversing vessels, most conspicuous laterally. The collections are near isointense to CSF on all sequences, and remain only minimally hyperintense as suggested on coronal T1 postcontrast images. These measure up to approximately 5 mm in greatest thickness bilaterally. There is no significant prominence of extra-axial space along the anterior temporal lobes or anterior interhemispheric fissure to suggest underlying benign enlargement of subarachnoid spaces of infancy.The ventricles and sulci are within normal limits. The cisterns remain patent. There is no midline shift or mass effect. There are no areas of pathological enhancement. There is no diffusion abnormality.Normal flow-voids are demonstrated in the major intracranial vascular structures. The left cerebellar tonsil is minimally pointed in configuration, although does not appear to extend abnormally below the level of the foramen magnum. The remainder of the midline structures and craniocervical junction are within normal limits. There is scattered paranasal sinus opacification. There is also fluid opacification of bilateral middle ears and mastoids, greater on the right.
1.Essentially chronic small bilateral predominantly frontal subdural hematomas, with signal only very minimally greater than CSF on T1-weighted images, although evaluation is somewhat limited as detailed above.2.Multiple scattered areas of hemosiderin staining, with most conspicuous areas in the left anterior temporal region which may be subarachnoid in location, as well as more tubular appearing areas along the right parietal cortex likely near the gray-white junction. Other scattered foci are also more peripheral in location as well as possibly along the tentorium. Findings may relate to a shear injury mechanism, resulting in areas of focal axonal injury. Please correlate with any history of trauma, including nonaccidental trauma.3.Bilateral mastoid and middle ear fluid opacification. Please correlate clinically.