Patient is 17 month old female with history of intractable seizure disorder. Status post right frontal lobectomy. Now with right subdural hematoma and 4 minute generalized seizure o/n Large area of low density in the right frontal lobe with minimal air is believed to represent postoperative changes of patient's given history of right frontal lobectomy. Large frontal craniotomy on the right which extends across the midline is also noted. The bony flap appears fragmented and may represent associated fracture. Please correlate with surgical history. This examination is compared with prior MRI examination which makes evaluation of bony structures difficult however no definitive evidence of similar findings of fragmented bony flap was detected. The comparison CT examination is a pre- surgical study.Extra-axial fluid collection under the craniotomy flap has mixed density and is consistent with epidural hematoma.There is evidence of mass-effect by the above findings however no definitive evidence of midline shift is detected.
1.Changes in the right frontal lobe with no hemorrhage are believed to represent postoperative change.2.Large epidural collection under the craniotomy flap consistent with hemorrhage.3.The bony flap is fragmented which may be postsurgical change however I cannot entirely rule out fracture.