Clinical question: Patient more lethargic today. Signs and symptoms: Acute mental status change. Lethargic. Unenhanced head CT:Since prior examination from 7 -- 19 -- 11 there is no evidence of any new intracranial hemorrhage. Previously seen small patchy areas of superficial located cortical and subcortical as well as minimally of the subarachnoid hemorrhage remains essentially stable since prior exam.Extensive area of low attenuation involving the cortex and subcortical white matter of right frontal and parietal lobes with extension into the right posterior temporal is also stable in appearance since prior study. Findings are believed to represent extensive encephalomalacia however new overlapping ischemic changes can be obscured. If patient has new symptoms recommend follow-up with an MRI exam.There is evidence of a large right temporal -- frontal craniotomy and small amount of air under the craniotomy flap. A combination of postop changes as well as parenchymal changes results in mass effect and midline shift are proximately 9 mm. There Is evidence of interval increase in the midline shaft which on prior exam measured between 5 to 6-mm.expected residual air within the subarachnoid space in the peri-surgical site remains stable.
1.Interval increase in leftward midline shift since prior exam.2.No definitive evidence of any additional new findings in the brain parenchyma since prior study.3.Previously noted small amount of parenchymal and subarachnoid hemorrhage in the surgical site shows no interval change.4.Very extensive right hemispheric encephalomalacia/edema remains similar to prior study.5.Recommend further follow-up with an MRI examination if clinical concern persists.