50 year-old female with change in mental status following craniotomy. Evaluate for hemorrhage. Postoperative changes status post bifrontal craniotomy, with pneumocephalus, surgical hardware, and skin staples evident. Previously described partially calcified lesions along the anterior interhemispheric fissure just right of midline and along the high left frontal convexity are unchanged. There is marked low attenuation within the frontal lobes, right greater than left, corresponding to edema seen on MRI. An area of focal low attenuation is seen in the medial left frontal lobe, concerning for ischemia. Punctate high attenuation in the medial left frontal lobe may represent calcification or hemorrhage, though thrombus within the anterior cerebral artery may have this appearance.A small curvilinear focus of high attenuation is seen in the medial right frontal lobe inferior to the partially calcified lesion, which may represent a small focus of hemorrhage. The degree of leftward midline shift has slightly increased, with ventricular volumes unchanged. The remainder of the cerebral and cerebellar hemispheres and brainstem demonstrate normal morphology and attenuation. Postoperative changes affect the frontal bones, with the remainder of the calvarium and osseous structures appearing intact. There is partial opacification of the left anterior ethmoid air cells, with the remainder the visualized paranasal sinuses and mastoid air cells are normally pneumatized.
1. Focal low attenuation in the medial left frontal lobe, suspicious for anterior cerebral artery territory or venous infarction.2. Extensive postoperative changes with residual tumor and mass effect as described.