Female, 10 years old, with history of strep pneumonia sepsis and meningitis with right temporal soft tissue swelling and dural defect. Evaluate for abscess, infection. Findings are demonstrated compatible with bilateral temporal region synangiosis.The previously demonstrated extracranial fluid collection along the right temporal scalp has resolved. No residual fluid or edema is seen. Dense enhancement within the subcutaneous tissues is compatible with scarring and/or granulation tissue. A small amount of right temporal parenchyma continues to herniate through the calvarial defect with minimal signal abnormality suggesting gliosis.Scattered areas of sulcal and intraventricular diffusion restricting infectious material, as well as areas of leptomeningeal enhancement, have resolved. A small area of somewhat prominent enhancement along the right anterior clinoid process (see image 45 series 1601) is favored to represent an aggregation of vascular structures or perhaps some granulation tissue. No associated parenchymal edema is seen. Elsewhere, no pathologic intracranial enhancement is suspected.Chronic strokes are redemonstrated in the left perirolandic area and in the basal ganglia, similar to prior. No acute ischemia is seen. No significant generalized mass effect is detected. There are no findings to suggest acute intracranial hemorrhage or any abnormal extra-axial fluid collection. Chronic hemosiderin staining in the basal ganglia, left more than right, is unchanged. The ventricles remain slightly prominent but similar to prior.Dedicated imaging of the IACs shows normal fluid signal characteristics of the inner ear structures. The IACs are patent and free of mass lesions. The visualized cranial nerves are unremarkable and show no evidence of pathologic enhancement. Since the prior examination, opacification of the right mastoid air cells has nearly completely resolved.
1.Interval resolution of findings related to infection and abscess formation along the right temporal scalp. Residual enhancing subcutaneous tissue likely represents scarring.2.Interval resolution of findings related to intracranial infection/meningitis. No significant sequelae or resulting brain lesions are seen. Mildly prominent enhancement along the right anterior clinoid process is favored to represent an aggregate of vascular structures or perhaps some granulation tissue.3.Unremarkable evaluation of the IACs.4.Redemonstration of findings related to moyamoya disease including prior cortical and basal ganglia strokes.