Clinical question: Status post ETV with fever. Signs and symptoms: As above. Pre and post enhanced brain MRI:There is an irregular focus of acute hemorrhage in the right basal ganglia with mild surrounding vasogenic edema and mass effect resulting in trace deviation of midline to the left. There is mild surrounding enhancement on postcontrast infused images. Edema appears to minimally extend into the superior right cerebral peduncle. Subtle FLAIR and T2 hyperintensity extends from this finding superiorly to the right frontal cortex at the level of a right frontal burr hole along the track of catheter insertion. Findings demonstrate no significant change compared to prior head CT examination. Mildly prominent supratentorial ventricular system remain stable since prior exam.Additionally examination demonstrate a well-demarcated focus of T2/FLAIR hyperintensity of the quadrigeminal plate without surrounding edema or enhancement. This finding measures approximately 11 x 7 mm in transaxial dimensions. Findings results in partial effacement of the aqueduct. Comparison to prior exams demonstrate no convincing evidence of interval change in the size of this lesion.Calvarium is unremarkable.Unremarkable images through the orbits, paranasal sinuses and mastoid air cells.
1.Hemorrhage and surrounding edema in the right basal ganglia along the course of a right frontal approach ventricular catheter and its associated mass effect on the third ventricle remains fairly similar to prior exams.2.Stable mildly prominent supratentorial ventricular system since prior CT examinations.3.Well-demarcated nonenhancing FLAIR/T2 hyperintensity of the quadrigeminal plate measures at 7 x 11 mm in size consistent with a mass demonstrate no significant change since prior exam.4.Unremarkable exam otherwise as detailed above.