Clinical question to be answered: Evaluate interval change. Signs and symptoms: Worsening mental status. In comparison with the prior examination extensive post operative changes remain stable. Extensive CSF collection under the scalp is redemonstrated. Intracranially no evidence of any new area of hemorrhage. There is however a significant thickening and minimally high density of the cortex of the left hemisphere possibility of petechial hemorrhage within this thickened cortex is suspected. This can be further evaluated by an MRI. Multiple areas of low attenuation (likely edema) within the cortex of the left hemisphere are consistent with areas of cortical stroke. Images at the level of the sylvian fissure on the left demonstrate thrombosed branches of left MCA. This is believed to be secondary to clipping of the feeding pedicles to the AVM.Overall degree of mass effect remains a stable and minimal midline shift demonstrates no interval change. Minimal blood within the dependent portion of the left lateral ventricle is redemonstrated. Minimal blood within the subarachnoid space on the right may be secondary to placement of pressure monitor.
Overall stable CT examination of brain. Please see above comments.