View ventricular size and any loculated areas for pre-op planning: prior EVD placement for onset of hydrocephalus after GBS meningitis. Brain: There is persistent, albeit slightly decreased, marked enlargement of the ventricular system, with interval insertion of a right transfrontal ventricular catheter that terminates in the left lateral ventricle, with a small amount of pneumocephalus. There is a defect in part of the septum pellucidum. There are persistent areas of cystic encephalomalacia and/or porencephaly, mainly in the bilateral posterior and inferior portions of the cerebral hemispheres and left frontal lobe. In particular, a cystic component in the right parietal lobe measures up to approximately 25 mm. There is now diffuse prominence of the bilateral supratentorial subdural spaces, particularly overlying the collapsed anterior left temporal lobe, measuring up to approximately 25 mm in width. There is extensive diffuse cerebral and brainstem white matter volume loss, but no evidence of acute infarction. There is susceptibility effect along the choroid plexi and posterior margins of the lateral ventricles related to chronic blood products, but no evidence of acute intracranial hemorrhage. In addition, there are punctate foci of susceptibility effect along the left caudothalamic groove and posterior fourth ventricular margin, also consistent with chronic hemorrhage. There are punctate foci of T1 hyperintensity in the bilateral basal ganglia. There is no midline shift or herniation. There is no evidence of acute infarction or hemorrhage. The orbits are unremarkable.Pituitary: The pituitary gland is normal in size and signal characteristics, including a posterior pituitary bright spot. The infundibulum is intact.
1. Findings compatible with extensive diffuse chronic cerebral infarction related to neonatal group B streptococcal meningitis with persistent areas of cystic encephalomalacia and/or porencephaly, 2. New subdural fluid collections, likely commensurate to slightly diminished ventriculomegaly, status post interval right transfrontal shunt catheter insertion.2. The pituitary gland appears to be unremarkable.