Altered mental status, unspecified [R41.82], Reason for Study: ^Reason: AMS (decreased alertness/responsiveness, non-verbal) w/ hx of SDH s/p crani and evacuation w/ new hypernatremia and UTI. CT head w/o acute change. History: Please see above Post left fronto parietal cranioplasty status follow up.There is no evidence of acute ischemic or hemorrhagic lesion.There is high signal intensity of the left frontal and parietal lobes underneath of the cranioplasty site which may indicate parenchymal edema. There is thin layer of extra axial fluid collections with evidence hemosiderin indicating blood products. There is 22.5mm x 36mm sized left parietal subgaleal fluid collection overlying the cranioplasty site.Underlying brain shows bilateral patchy high signal intensity lesions on periventricular white matter indicating non specific small vessel ischemic disease. Multifocal lacunar infarctions including right external capsule and left thalamiThe ventricles, sulci and cisterns are symmetric and unremarkable. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.
1. Post left fronto-parietal cranioplasty status with thin extra axial fluid collections without evidence of mass effects against underlying brain parenchyma.2. The left fronto-parietal lobe high signal intensity on T2/FALIR images were again seen which may indicate reactive changes after extra axial fluid evacuation.3. No evidence of acute ischemic or hemorrhagic lesion.4. Subgaleal fluid collections on the cranioplasty site.5. Non specific small vessel ischemic disease and multifocal lacunar infarctions.