Male, 24 years old. History of TBI, dystonic tremors, impulsive disorder, seizures, and underwent a DBS insertion on 9/16/15. The patient presented 10/9/15 with altered mental status. Again seen is evidence of the recently removed right frontal approach deep brain stimulator lead . The previously seen ovoid fluid collection in the right frontal lobe and insula is grossly stable in size, measuring 5.3 x 2.1 x 3.0 cm (series 7, image 21; series 8, image 26). The fluid collection only partially suppresses on FLAIR, indicating the presence of proteinaceous debris or diluted blood products, with a small amount of layering blood products posteriorly. There is new thin rim enhancement along this cavity, particularly as seen on late acquired postcontrast images. There is no diffusion restriction associated with this collection. Moderate surrounding vasogenic edema in the right frontal lobe is not significantly changed from prior, with persistent local mass effect and mild leftward midline shift. There is no evidence of herniation. The lateral ventricles appear unchanged in configuration. There is persistent mild enhancement along the tract of the prior deep brain stimulator, which extends through the frontal lobe, nearly reaching the basal ganglia. The previously described peripherally enhancing subgaleal fluid collection at the site of the right frontal burr hole is not as clearly evident compared to the prior study. A right cerebellopontine angle area of CSF prominence appears similar to prior possibly representing a small arachnoid cyst .The cranial-cervical junction is normal. Normal flow-voids are demonstrated in the major intracranial vascular structures. There is mild scattered paranasal sinus mucosal thickening. The mastoid air cells, and orbits are unremarkable.
1.New rim enhancement surrounding the right frontal lobe/insular fluid filled cavity is of uncertain significance but could reflect granulation, reactive inflammation or infection. The size and shape of the cavity are unchanged. Likewise, there has been no change in enhancement along the deep brain stimulator lead tract.2.No significant change in the extent of edema in the right frontal lobe and associated local mass effect.