Female, 68 years old, with coma. Bilateral subdural collections are seen showing intermediate T1 signal intensity and mixed T2 signal intensity. There has been no significant interval change in size when compared to prior CT examinations. Thin subdural blood product is also evident along the interhemispheric falx and the tentorium.As on prior exams, these collections measure up to 10 mm in thickness and exerts generalized mass effect upon the brain. The sulci are effaced and the lateral ventricles are narrowed. The basilar cisterns are effaced with herniation of the medial temporal lobes across the tentorial incisure.Patchy restricted diffusion is evident within the midbrain and pons. There is some associated patchy susceptibility within the pons as well which may reflect petechial hemorrhage versus vascular engorgement. Very subtle restricted diffusion is also seen within the posterior medial left temporal lobe and to a mild degree within the left medial occipital lobe, better seen on the ADC map. The midbrain and pons are edematous resulting in crowding of the posterior fossa structures. The fourth ventricle is nearly completely effaced.On postcontrast images, there appears to be a developmental venous anomaly within the pons. No other pathologic intracranial enhancement is seen.
1.Bilateral subdural hemorrhages are stable in size.2.Generalized mass effect upon the brain is seen with crowding of the sulci and partial effacement of the lateral ventricles. The medial temporal lobe parenchyma is herniating to a mild degree across the tentorial incisure. This contributes to crowding and mass effect upon the brainstem.3.Patchy restricted diffusion is seen within the midbrain and pons compatible with ischemia. The pontine signal abnormality associated with patchy susceptibility which could represent small Duret hemorrhages or possibly just vascular engorgement.4.The pons is edematous which contributes to crowding of the posterior fossa structures. The fourth ventricle is partially effaced.5.Very mild restricted diffusion is seen within the posterior medial left temporal lobe and medial left occipital lobe compatible with developing ischemia.The finding of medial temporal lobe herniation was text-paged to Dr. Dellaria at 3:20 PM on 6/28/15.