69 years Male (DOB:6/14/1946)Reason: eval tumor resection History: seizuresPROVIDER/ATTENDING NAME: BAKHTIAR YAMINI BAKHTIAR YAMINI The patient has undergone parietal craniotomies and cranioplasty for removal of a meningioma which involve the superior sagittal sinus. There are associated postoperative changes with intracranial air and subcutaneous air and soft tissue swelling. There is an extra-axial collection present at the craniotomy site measuring up to 13 mm in thickness. This collection is associated with some mild displacement of the adjacent brain. There is redemonstration of white matter T2 and FLAIR corresponding to T2 and FLAIR hyperintensities on the prior MR located within the left frontal and parietal lobes as well as the right parietal lobe, left external capsule, left posterior limb of internal capsule and the small portion of the posterior medial aspect of the right frontal lobe white matter. There is associated midline shift with shift of the septum pellucidum approximately 5 mm to the right of midline.There is contrast enhancement along the surface of the brain at the surgical resection site. No convincing evidence for residual tumor.There is a focus of diffusion restriction present centered in the right caudate nucleus measuring 16 x 18 mm axial dimensions. This associated with FLAIR signal hyperintensity. There are multiple punctate foci of diffusion restriction scattered throughout both hemispheres of the brain and along the left occipital lobe and to a lesser degree right occipital lobe. These are associated with FLAIR signal hyperintensity.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins. The anterior aspect of the superior sagittal sinus is identified but not the posterior aspect of the superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate only minor opacities. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.
1.Status post craniotomy and cranioplasty for removal of a meningioma. There is no convincing evidence for residual meningioma is appreciated. There are associated postoperative changes with intracranial air and subcutaneous air and soft tissue swelling.2.There is an extra-axial collection with mild mass effect at the craniotomy site. The white matter edema associated with a meningioma identified on the prior exam persists.3.Subacute infarction involving the right caudate nucleus4.Multiple microinfarcts scattered in both hemispheres of the brain.