Chronic postconcussive headache after patient hit in head with hammer. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are scattered mild cerebral white matter T2 hyperintense lesions. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. There appears to be a small residual right frontal scalp hematoma. The orbits, skull, and mastoid air cells are grossly unremarkable. There is mild scattered paranasal sinus mucosal thickening. There are postoperative findings in the upper cervical spine.
1. Apparent small residual right frontal scalp hematoma, but no evidence of intracranial hemorrhage. 2. Scattered mild cerebral white matter lesions are nonspecific, but likely represent chronic small vessel ischemic disease.