62 year old male with cognitive slowing. Evaluate for recurrence of sinus thrombosis and/or ischemia. Additional history includes dural AV fistula (left occipital draining into straight sinus) status post resection on December 2012. Also history of stage III nasopharyngeal cancer. Redemonstrated are postsurgical changes of a prior left suboccipital craniotomy for resection of a left dural AV fistula. There is interval increase in T2/FLAIR hyperintensity in the left occipital lobe as well as in the the left cerebellar hemisphere with volume loss favored to represent encephalomalacia but progressed since prior study from 2013. There are vascular clips along the left tentorial leaf which preclude evaluation on susceptibility and diffusion-weighted sequences. No evidence of acute infarct or new hemorrhage is appreciated.A tubular area of encephalomalacia begins near a right frontal burr hole within the right superior frontal gyrus and extends to the right frontal horn periventricular region, which may be related to prior instrumentation. Gliosis along the tract is increased since prior study from 2013.Again demonstrated are multiple small foci of susceptibility abnormality within the basal ganglia and right thalamus, appearing similar to the previous examination which may be related to the previous vascular congestion. There are also a few punctate foci of susceptibility along the posterior aspect of the right lateral ventricle which may be chronic hemosiderin deposition from the prior procedure. The medial aspect of the left transverse sinus is diminutive compatible with chronic occlusion as before. The distal aspect of the transverse sinus, sigmoid sinus, and left jugular vein appear patent. Remainder of the major intracranial venous system also appears patent.There is no abnormal brain parenchymal enhancement, mass, mass effect, midline shift, hydrocephalus. There is mild global parenchymal volume loss. A small enhancing mass is seen with T2 hyperintensity measuring up to 17 x 12 mm, coronal T2 image 20 mm, within the right deep lobe of the right parotid gland and not significantly changed in size since remote MRI dated 11/11/2012. There is an opacity in the left inferior mastoid air cell. There is mild diffuse paranasal sinus mucosal thickening.
1.Compared to MRI brain dated 5/6/2013, there is increase in T2/FLAIR hyperintensity in the left cerebellar hemisphere as well as in the left occipital lobe with also increase in volume loss likely representing evolution of encephalomalacia. There is also increase in FLAIR signal abnormality favored to represent increased gliosis along the prior right frontal surgical tract. There is no otherwise no new focus of edema, hemorrhage, or infarct.2.The medial aspect of the left transverse sinus appears chronically occluded as before. Remainder of the major venous system appears patent.3.Postsurgical changes of a prior left suboccipital craniotomy for resection of a left dural AV fistula. 4.Small enhancing mass within the deep lobe of the right parotid gland which is not significantly changed in size since 2012 and favored to represent a pleomorphic adenoma.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.