Clinical question: Evaluate subdural hematoma. Signs and symptoms: Headache. Pre and post enhanced brain MRI:Diffusion weighted images are partially obscured due to metallic artifacts in the posterior fossa on the left as well as right anterior cerebral hemisphere. Beyond the artifacts no evidence of acute ischemic process is noted.Examination demonstrates significant interval decreased size of right hemispheric convexity subdural since prior study. A small residual right anterior frontal subdural measures maximum of 7 mm in thickness with subtle mass effect on the adjacent parenchyma. A large left hemispheric convexity subdural is again noted. There is slight interval increased size of subdural since prior study. In the left anterior subdural measures approximately 22 mm in thickness compared to prior study measurement of 17. In the left posterior frontal the subdural measures approximately a 22 mm compared to prior study measurement of 18. There is also subtle interval increased susceptibility signal within the subdural since prior study suggestive of new hemorrhage or be secondary to interval surgical intervention. There is a new right frontal burr hole since prior study.There is interval increased size of supratentorial ventricular system and with evidence of new midline shift of approximately 7 mm at the level of septum pellucidum.Metallic artifact from multiple surgical clips in the right sylvian fissure and a catheter in the posterior fossa on the left is noted. There are few small foci of subcortical and periventricular FLAIR hyperintensity which are more conspicuous on current exam likely secondary to decreased right sided subdural. Similar to prior exam on post enhanced images there is thickening and enhancement of dura along the entire extent of bilateral subdurals. There is also similar to prior exam there is a ringlike focus of enhancement at approximately the level of the tip of left posterior fossa catheter measuring at 6 x 10 mm on axial post enhanced series 12 image 8.
1.Significant interval decreased size of right hemispheric convexity subdural with 7 mm thick right anterior frontal residual.2.Slight interval increased size of left hemispheric convexity subdural as detailed/measured above.3.Interval mild enlargement of supratentorial ventricular system and new rightward deviation of midline of 7 mm.4.New left sided burr hole and subtle signal changes within the left subdural suggestive of new hemorrhage.5.Similar to prior exam dural thickening and enhancement along bilateral subdurals are again identified.6.Small focus of enhancement at the level of tip of posterior fossa catheter on the left is again noted.