 Redemonstrated are changes from left temporal craniectomy with interval increase in extent of transcranial herniation associated with an increase of left occipital horn ex vacuo dilatation. Gliosis and susceptibility from hemosiderin staining is again noted along the operative approach. Dural thickening and enhancement is noted at the craniectomy site, however without an associated fluid collection. There remains smooth dural thickening and enhancement involving the left tentorium, above that normally expected. Additionally, there remains enhancement along the superior aspect of the operative approach. Previously demonstrated scalp enhancement has nearly resolved.There is new T2 hyperintensity associated with new mild mass effect involving the expected locations of the inferior olivary nuclei (best seen series 1801, image 5/30).The most recently documented CT hyperdense lesion, corresponding with cerebral cavernous malformation on comparison MRI, is again noted within the left posterolateral pons, without residual perilesional edema. When compared to the comparison MRI, there has been a change in character of the intrinsic components. Specifically, there has been an interval increase in septation and components demonstrating a more cystic fluid-like appearance,.There is no midline shift. Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. Left mastoid fluid signal has resolved.
1.The patient was nonverbal and moving throughout the exam, necessitating protocol modifications including some fast-scanning techniques.2.Redemonstrated are changes from left temporal craniectomy with interval increase in extent of transcranial herniation associated with an increase of left occipital horn ex vacuo dilatation. 3.There is new T2 hyperintensity associated with new mild mass effect involving the expected locations of the inferior olivary nuclei, most likely secondary to hypertrophic olivary degeneration.4.Left pontine cerebral cavernous malformation without residual perilesional edema.