History of subdural hematoma, now 2 week history of intermittent right lower extremity and right upper extremity weakness/numbness. Evaluate for subacute stroke. Again seen are subdural collections along the bilateral cerebral convexities, measuring up to 25 mm on the right, previously 15 mm in a similar plane from CT dated 4/24/2015, and up to 9 mm on the left previously 9 mm as well. There is susceptibility consistent with blood products within the right-sided collection with mild loculations. There is increased mass effect on the right frontoparietal sulci, effacement of the right lateral ventricle, and increase in leftward midline shift from 3 mm to 8 mm at the level of the septum pellucidum. No uncal herniation. Minimal subdural blood products also suspected in the posterior fossa bilaterally. Small fluid collection in the right parietal scalp is again noted measuring up to 9 mm x 3.9 cm in the transverse and AP dimensions which communicates with the subdural collection via the prior posterior burr hole. Mild enlargement of the left lateral ventricle is noted which may be getting entrapped.No restricted diffusion to suggest acute ischemia. Again seen are multiple foci of T2/FLAIR hyperintensity in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with moderate chronic small vessel ischemic changes and similar to prior. Major flow-voids are preserved. Parenchymal volume loss is noted particularly on the left.Partially empty sella incidentally noted. Minimal mucosal thickening in the paranasal sinuses. Bone marrow signal and extracranial soft tissues are within normal limits. Two right-sided burr holes again noted.
1. Compared to CT 4/24/2015, there is interval increase in size of right frontoparietal convexity subdural hematoma measuring up to 25 mm, previously 13 mm. There is significant increase in mass effect with leftward midline shift measuring 8 mm, previously 3 mm. Mild enlargement of the left lateral ventricle is also noted which may be getting entrapped. 2. No significant change in small left-sided subdural collection with signal features mostly compatible with a hygroma. No significant mass effect. 3 Small right parietal scalp fluid collection again noted which communicates with the subdural collection via previously placed burr hole.4. Moderate chronic small vessel ischemic disease. No evidence of recent infarct.Dr. Ali discussed findings with Dr. Cotts at 1050 on 5/15/2015. Patient was transported to the ED for further evaluation.