 Since the prior brain MRI from 9/6/2016 there has been significant increase in size of a subdural hematoma along the left cerebral convexity which measures up to 22 mm in thickness, previously 12 mm. There are areas of T1 hyperintensity indicative of subacute hemorrhage, new since prior. There is increased effacement of the adjacent left frontal and parietal sulci. There is minimal rightward midline shift measuring up to 3 mm.There is no evidence of acute infarct. There is encephalomalacia in the right frontal lobe related to prior trauma. There is mild prominence of the overlying extra-axial CSF space suggesting a small leptomeningeal cyst, with prior study demonstrating heterogeneous extra-axial blood products in this region. There are also foci of T2/FLAIR hyperintensity in the left frontal subcortical white matter which are also compatible with sequela of prior trauma. Punctate chronic blood products in the left posterior left temporal lobe are also again seen. Ventricles remain normal in size. Biparietal skull fractures are better demonstrated on same-day CT.MR venogram demonstrates a normal variant right dominant transverse and sigmoid sinus. Previously seen outpouching involving the midportion of the superior sagittal sinus is no longer discretely appreciated. The superior sagittal sinus is patent. The inferior sagittal sinus, transverse sinuses, sigmoid sinuses, straight sinus, vein of Galen, internal cerebral veins, and several visualized cortical veins are patent.
1. Significant interval increase in size of a left-sided subdural collection with MRI signal features and same-day CT findings suggesting subacute subdural hematoma, with new areas of hyperdensity/T1 shortening indicating new hemorrhage. There is increase in associated mass effect.2.Encephalomalacia in the right frontal lobe with suggestion of a small overlying "leptomeningeal cyst". Mild separation of the right parietal fracture fragment better demonstrated on CT.3.Patent venous system. Focal outpouching involving the mid aspect of the superior sagittal sinus seen on CTA dated 8/27/2016 is no longer discretely perceptible.Dr. Ali discussed findings with Darlene Simkhin (Dr. Frim's nurse) at 1630 hrs on 11/9/2016