Clinical question: Evaluate for ischemic change. Signs and symptoms: Comatose. Nonenhanced brain MRI:Examination demonstrate diffuse scattered varying size restricted diffusion in bilateral hemispheric cortical, subcortical white matter, basal ganglia and pontine as well as left cerebellum consistent with acute ischemic strokes.Postoperative changes of a right craniectomy for evacuation of hematoma is noted. There is a hemorrhagic surgical cavity measuring approximately at 22 x 20 mm in size and the diffuse surrounding FLAIR hyperintensity suggesting edema. No significant change in the extent of this finding when compared with prior PET/CT study.Postoperative changes of a large right-sided craniectomy with an underlying extra-axial collection is noted. It measures approximately 16 mm in thickness without significant change since prior study. There is mass effect and deviation of midline to the left of approximately 12 mm which is also nearly identical to prior exam. The ventricular system are within normal size and stable since prior exam.Diffuse subgaleal increased T2 and FLAIR signal intensity beyond the right-sided hemicraniectomy in the left high convexity posterior parietal region is noted.
1.Multiple varying sized foci of restricted diffusion involving bilateral cerebral cortex, subcortical white matter, basal ganglia and left pontine as detailed.2.Extensive postoperative changes are right sided craniectomy for evacuation of right hemispheric hematoma demonstrate no significant change since prior exam.3.Constellation of changes in the right hemisphere and including 12 mm deviation of midline to the left demonstrate no significant change.4.Stable nondilated ventricular system.5.Stable hemorrhagic postoperative surgical cavity and its surrounding edema.6.Stable extra-axial collection measuring at 16 mm in thickness in the right frontal temporal.