Clinical question: AMS since shunt placement. Signs and symptoms: AMS since shunt placement. Pre and post enhanced brain MRI:Diffusion weighted images are partially obscured by extensive metallic artifact obscuring the right aspect of posterior fossa, right mid and posterior temporal lobe and portion of right parietal. Beyond the region of artifact no evidence of restricted diffusion detected.Stable extensive bilateral periventricular FLAIR hyperintensity since prior exam.Interval decreased size of chronic hemorrhagic changes in the right frontal along the course of previously removed right ventricular catheter. Mild residual blood still detected. Compared to prior study there is suggestion of mild interval decreased size of supratentorial ventricles. A right posterior temporal approach ventricular catheter is a new finding since prior exam. The catheter traverses the brain parenchyma, enters the right lateral ventricle and the tip in the anterior aspect of body of right lateral ventricle and intermediate and right paramedian location. There is edema of right posterior temporal-parietal parenchymal at the site of new catheter. Images through posterior fossa are unremarkable and stable since prior study.The signal void of major intracranial arterial branches are identified.Unremarkable images through the orbits.
1.No detectable acute intracranial process and negative diffusion-weighted images.2.New right posterior temporal-parietal ventricular catheter with the tip in the anterior right lateral ventricle. 3.Mild interval decrease size of ventricular system and focus of edema at the site of catheter entry in the right posterior temporal-parietal region.4.Stable examination otherwise and with revisualization of extensive periventricular FLAIR hyperintensity since prior study.5.Interval decreased size of focus of hemorrhage in the right frontal along the course of the previously removed catheter.