 Artifact from the shunt device limits evaluation in the left parietal and occipital lobes and posterior fossa. Shunt tubing enters through a left parietal burr hole and has its tip in the posterior horn of the left lateral ventricle. A small amount of increased T2 signal intensity is present anterior to the shunt tubing otherwise there is no abnormal parenchymal signal. A second catheter is seen along the left temporal lobe coursing through the sylvian fissure.There is prominent extra-axial fluid along the left frontal lobe with posterior displacement of the frontal lobe and mass effect on the left lateral ventricle which is asymmetrically smaller compared to the right. There is also prominence of CSF along the anterior left temporal lobe. The prepontine cistern is prominent. There may be a small ependymal cyst at the level of the atrium of the right lateral ventricle curving along the right lateral thalamus and into the temporal lobe.The superior vermis is small and slightly dysmorphic in appearance. The junction of the vein of Galen and straight sinus appears abnormally superiorly positioned which probably contributes to the appearance of a tall and thin superior vermian cistern. The contour of the roof of the fourth ventricle is also atypical in that the superior medullary vellum is relatively convex superiorly.No acute abnormal bodies are seen. No parenchymal edema is detected.
1.Asymmetric but nondilated ventricles.2.Areas of prominent extra-axial CSF and mass effect on the left cerebral hemisphere may be related to cysts.3.Mildly dysmorphic brain parenchyma is likely chronic.