37-year-old female with history of shunt, now with difficult to control seizures and altered mental status. Evaluate ventricles. Evaluate shunt. CT at outside hospital two weeks ago said there was subarachnoid hemorrhage. Possible PRES. There is diffuse cerebral edema with increased density surrounding the basal cisterns and cerebellar tentorium compatible with pseudo-subarachnoid hemorrhage. Low attenuation is seen throughout the cerebral convexities bilaterally involving the bilateral frontal and occipital lobes. There is crowding at the level of the foramen magnum suggestive of ectopia versus artifact. All the cisterns are effaced.There is a focus of high attenuation within the right posterior occipital lobe compatible with hemorrhage this may be secondary to hypertensive hemorrhage.The ventricles are mildly enlarged however not significantly different compared to the previous MRI brain dated 3/11/2005.Again noted is a shunt catheter which traverses the right lateral neck soft tissues the catheter tip terminates within the foramen magnum and upper cervical spine. Within the limits of CT examination there is no evidence of shunt discontinuity or kinking.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.
1. Diffuse cerebral edema with multifocal patchy white matter hypoattenuation with focus of parenchymal hemorrhage in the right occipital lobe compatible with hypertensive hemorrhage. Further evaluation with MRI may be considered as clinically indicated2. No evidence of subarachnoid hemorrhage as clinically questioned.3. Shunt catheter at the level of the foramen magnum and upper cervical spine without evidence of discontinuity or kinking.