Unexplained left sided weakness after seizure and trauma. Brain: There is a predominantly high T1 and low T2 signal intensity left holoconvexity subdural hematoma that measures up to 12 mm in thickness. There is associated mild mass effect upon the left cerebral hemisphere, 3 mm of midline shift to the right, and partial effacement of the left lateral ventricle, and mild prominence of the right alteral ventricle with diffuse mild periventricular white matter T2 hyperintensity. There is also a punctate focus of susceptibility effect in the right paracentral lobule with mild associated vasogenic edema, patchy T2 hyperintensity in the right cerebral peduncle, a small patchy area of T2 hyperintensity in the inferior portion of the anterior left putamen, punctate foci of high T2 signal in the posterior left insular subcortical white matter and posterior left hippocampal tail, as well as punctate foci of susceptibility in the left thalamus, right superior frontal gyrus, right lateral anterior temporal lobe, and left lateral medulla. Some of the areas with high T2 signal may display mildly restricted diffusion. There is a partially empty sella. The major cerebral flow voids are intact. The orbits, paranasal sinuses, and scalp soft tissues are grossly unremarkable. The skull bone marrow signal displays diffusely low T1 and T2 signal. There is a T2 hyperintense nodule in the superficial left parotid gland, which measures up to 9 mm.Cervical Spine: The vertebral body and disc space heights are preserved. The vertebral bone marrow signal displays diffusely low T1 and T2 signal. There is no significant spinal canal stenosis. The spinal cord displays normal signal and morphology. There is no spondylolisthesis. The paravertebral soft tissues are unremarkable. However, there is diffuse reticulation of the subcutaneous fat. There are enteric and endotracheal tubes in position.
1. Subacute left holoconvexity subdural hematoma that measures up to 12 mm in thickness, with associated mild mass effect upon the left cerebral hemisphere, 3 mm of midline shift to the right, and partial effacement of the left lateral ventricle.2. A punctate focus of hemorrhage in the right paracentral lobule with mild associated vasogenic edema, patchy T2 hyperintensity in the right cerebral peduncle, a small patchy area of T2 hyperintensity in the inferior portion of the anterior left putamen may represent sequelae of trauma, including hemorrhagic contusions and shear injury, and Kernohan notch phenomenon, perhaps. Nevertheless, underlying microhemorrhages from other causes are a consideration and follow up brain MRI may be useful. 3. No evidence of spinal canal stenosis. 4. Diffuse low signal of the bone marrow may represent a marrow replacement disorder.5. Incidental subcentimeter left parotid tumor may represent a pleomorphic adenoma, for example. Follow up with dedicated imaging may be useful.Discussed with Dr. Kramer at 4:15 PM on 4/28/16.