29-year-old woman with history of Rasmussen's encephalitis status post right hemispherectomy at age 7, complicated by hydrocephalus status post drainage and multiple revisions ultimately removed 11/1/2016. These procedures have also been complicated by wound dehiscences. There are extensive postoperative changes of right craniectomy and hemispherectomy, similar to the prior examination. A dominant extra-axial fluid and air collection appears minimally smaller compared to the prior examination (701/22). A second, smaller extra-axial fluid collection along the anterior craniectomy margin (701/23) is stable in size. Multiple left cerebral CSF signal cysts are not appreciably changed in the interval. There is extensive T2 hyperintense signal within the posterior left cerebral white matter, similar in distribution and extent to the prior examination and likely reflect gliosis. Additional foci of T2 hyperintense signal in the left cerebral peduncle and left thalamus appears similar to prior examinations. Volume loss with increased T2 signal in the right posterolateral partially imaged cervical cord also appears unchanged.There is no restricted diffusion to suggest acute ischemia. There is no acute intracranial hemorrhage. No new mass or mass effect.The orbits and paranasal sinuses are unremarkable. The bone marrow signal is unremarkable. The soft tissues overlying the right craniectomy appear intact.
Extensive remote postoperative changes of right craniectomy and hemispherectomy with minimally decreased size of right-sided extra axial air and fluid collection. Otherwise, underlying parenchymal findings are not significant changed from 11/4/2016 including intraparenchymal cysts and extensive surrounding T2/FLAIR hyperintensity in the left cerebral white matter which at least predominantly reflect gliosis, although a small component of vasogenic edema not entirely excluded.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.