58 year-old the female status post craniotomy for epilepsy, complaint of headache There is post craniotomy change at the right temporal region. Images demonstrate subcutaneous soft tissue edema, small amount of extra axial fluid collection and pneumocephalus along the surgical incision, and patchy hyperattenuation blood and low attenuation air bubbles in the right temporal lobe surgical site. Hypodense signal in the right temporal lobe is likely a mixture of surgery cavity and vasogenic edema secondary to the surgical manipulation. All are expecting post surgery change. There is no evidence of large hematoma formation or hydrocephalus. The findings are similar to the MRI study done on 9/21/11.The gray-white matter differentiation is preserved in the remainder structure. However, the cortical sulci of the right cerebral hemisphere is effaced when compared to the contralateral side. There is minimal midline shift to the left approximately 3mm and mild compression of the right lateral ventricle. The findings are suggestive of parenchyma edema on the right, which is relative new when compare to previous MR study. In addition, there is small patchy hypoattenuation in the right frontal lobe cortex (image 18,19). This can be secondary to positioning, however, small ischemic change can not be completely excluded.There is large calcification along the anterior interhemispheric falx and the right frontal dura. The superior sagittal sinus appears hypoattenuation in density, which may secondary to blood loss. Except for craniotomy, the remainder calvarium is unremarkable. Calvarium, visualized paranasal sinuses, orbits and mastoid air cells are unremarkable.
1. Effacement of the cortical sulci with preserved gray-white matter differentiation of the right cerebral hemisphere, minimal midline shift and partial compression of the right lateral ventricle. The findings are suggestive of parenchyma edema.2. Expected post surgery change as detailed above.3. There is small patchy hypoattenuation in the right frontal lobe cortex. This can be secondary to positioning, however, small ischemic change can not be completely excluded. Non-infusion CT is not sensitive to detect early parenchyma ischemia. If cortical ischemia is suspected on clinical setting, a MRI study may help further evaluate. 