Subdural hemorrhage MRI of the brainThere are bilateral subdural effusions present adjacent to both hemispheres. The right one is larger than the left lung. The one on the right measures approximately 17 mm in thickness along the left measures approximately 17 mm in thickness. The subdural collections are hyperintense on T2 and FLAIR sequences and somewhat homogeneous. There is no evidence for any significant restriction of diffusion. There is associated diffuse pachymeningeal enhancement.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.No diffusion weighted abnormalities are appreciated.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.The patient is status post a drainage tube placement which courses through the left cerebellar hemisphere into the lateral aspect of the fourth ventricle and left foramen of Luschka. It appears be in stable position compared to prior CT exam. There is a focus of enhancing tissue at the anterior tip of the ventriculostomy tube adjacent to the 4th ventricle - along its left posterior inferior aspect - and adjacent to the left foramen of Luschka within the cerebellum. There is associated T2/FLAIR signal hyperintensity which is unchanged since the prior exam but larger than on 8/28/14. On August it measured 8mm whereas now it measures 12mm.MRA brain:Antegrade flow is present in the distal left internal carotid artery, the distal vertebral arteries, the basilar artery and the proximal left middle and bilateral posterior cerebral arteries. Artifact from aneurysm clips in the right middle cerebral artery region obscures visualization of the distal right internal carotid artery and the right middle cerebral artery as well as the right anterior cerebral artery and the anterior communicating artery region.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is obscured by artifact. There is fetal origin of the left posterior cerebral artery. The right posterior communicating artery is obscured by artifact. The vertebral arteries are similar in size.
1.There are bilateral subdural collections present which also been identified in the recent CT of the head and are associated with mass effect and compression of the underlying brain.2.There is a small lesion present at the tip of the ventriculostomy tube adjacent to the 4th ventricle and left foramen of Luschka in the left cerebellar hemisphere. This is not obviously changed since the prior exam from 12/30/14 (a non contrast exam) but larger than on the August exam. The possibility of progression cannot be excluded. DDX includes metastasis and radiation change/necrosis.3.There is diffuse pachymeningeal enhancement present which is non-specific. Possibilities include that this could be a reaction to prior surgery or the subdural hematomas. 4.Artifact from aneurysm clip significantly diminishes visualization of intracranial vasculature. No obvious aneurysms in the visualized vasculature are appreciated.5.Findings were discussed with Dr Awad.