History of congenital hydrocephalus. Rule out shunt malfunction. Fussiness and abdominal pain. There is redemonstration of abnormal cleavage of the forebrain and large associated dorsal cyst, findings consistent with holoprosencephaly. The appearance of the brain parenchyma is unchanged apart from subtle area of apparent mineralization in the right cerebral hemisphere possibly evolving site of prior insult or conceivably artifact. No parenchymal mass lesion or other focus of abnormal attenuation.There is redemonstration of a right posterior approach shunt catheter terminating within the dorsal cyst. There is no visible kinking or discontinuity in the visualized portions of the shunt catheter/reservoir system. Position of the tip is unchanged. There is also unchanged size of the dorsal cysts and rudimentary ventricular system with which it communicates, making allowances for technique differences. No new focal fluid collection or evidence of acute intracranial hemorrhage. There remains some tonsillar descent better seen on prior brain MRI. However, there is no frank brain herniation or gross midline shift.There remains macrocephaly with towering appearance of the cranial vault. Degree of sutural diastases appears to be diminished compared to the prior examination as expected with interval skull growth. There does remain some left-sided posterior plagiocephaly which was present previously.Paranasal sinuses are subtotally opacified and there is also opacification of the left mastoid air cells and middle ear cavities and the right mastoid air cells. Orbital contents are unremarkable.
Stable size of dorsal cyst and rudimentary ventricular system with which it communicates status post ventricular peritoneal shunt. No acute intracranial hemorrhage. Findings are consistent with lobar holoprosencephaly.