Male, 47 years old, with altered mental status, recent questionable subarachnoid hemorrhage with artery wrapping, assess for vasoconstriction. Findings are seen compatible with recent left pterional craniotomy. Epidural thickening beneath the craniotomy flap is seen measuring up to 8 mm and causing mild effacement of the adjacent frontal lobe sulci. There may also be trace subarachnoid blood product within the adjacent frontal sulci.Very mild restricted diffusion and correlating T2 signal abnormality is seen along the medial anterior aspect of the left thalamus (see key images).T2 hyperintensity is seen involving the posterior left gyrus rectus and olfactory gyri. A small amount of associated T1 hyperintensity is also seen possibly indicating minimal blood product.Numerous scattered small foci of T2 hyperintensity are evident elsewhere in the cerebral white matter. No other areas of significant parenchymal edema or mass effect are detected. No other significant areas of intracranial hemorrhage are seen. The ventricles are normal in size and morphology.Patchy enhancement is seen along the left anterior sylvian fissure. The dura and some of the frontal lobe sulci beneath the craniotomy also show mild enhancement.MRA images of the intracranial circulation are suboptimal due to motion artifact. No significant stenosis or occlusion is seen within the proximal circle of Willis branches, but beyond the first order branches, assessment is unremarkable.
1.Findings compatible with mild subacute ischemic injury to the anterior medial left thalamus.2.Findings compatible with parenchymal injury involving the posterior left gyrus rectus and olfactory gyri which, given the location, are probably postoperative in nature.3.Epidural thickening subjacent to the craniotomy is seen measuring up to 8 mm but with no evidence of restricted diffusion. Mild enhancement of the adjacent dura and some of the frontal lobe sulci is seen. Given the lack of parenchymal edema, these findings are felt to be reactive to surgery rather than inflammatory or infectious.4.Scattered small foci of white matter signal abnormality are seen, a nonspecific finding which can reflect chronic microvascular ischemic disease among many other etiologies.