Clinical question: Worsening encephalopathy. Signs and symptoms: Encephalopathic Extensive vasogenic edema of the left frontal and parietal lobes and to a lesser degree of right frontal lobe is noted. These findings were not identified on prior CT examination of the brain. Review of prior MRI examination of brain from 11 -- 17 -- 2009 demonstrated similar findings. There is extensive effacement of cortical sulci throughout bilateral cerebral hemispheres. There is no evidence of hydrocephalus and no midline shift is detected. There is no evidence of hemorrhage. Basal cisterns and all the other CSF cisterns remain patent. Calvarium, limited real paranasal sinuses and mastoid air cells are also unremarkable. High density within the superior sagittal sinus it could represent previously recognized thrombosed superior sagittal sinus.
Bihemispheric frontal -- parietal areas of vasogenic edema without hemorrhage secondary to patient's known intracranial sinus thrombosis.