Subdural hematomas; secondary CNS lymphoma s/p WBRT: bilateral 3rd nerve palsy and balance issues. There are bilateral high T2 and intermediate to high T1 signal posterior cerebral convexity subdural hematomas, measuring up to 12 mm on the right and 10 mm on the left. Linear hypoattenuating components within the bilateral subdural collections may represent membrane formation. There is also diffuse smooth cerebral convexity dural enhancement and thickening bilaterally, which may be reactive. There is mild mass effect upon the underlying brain parenchyma, but no significant midline shift or herniation. There is no evidence of acute infarct. There is diffuse confluent periventricular white matter T2 hyperintensity. There are postoperative findings related to right transfrontal biopsy, but no evidence of intracranial tumor. There is a punctate focus of enhancement and susceptibility effect in the anterior periaqueductal region. In addition, there are unchanged areas of susceptibility effect and enhancement in the posterior right temporal and frontal periventricular regions. There are also unchanged punctate foci of susceptibility effect in the bilateral anterior frontal lobe periventricular regions. There is mild diffuse cerebral and cerebellar volume loss. Otherwise, the punctate focus of enhancement in the right insula is less conspicuous. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.
1. Persistent subacute upon chronic bilateral posterior cerebral convexity subdural hematomas.2. Unchanged punctate focus of enhancement and susceptibility effect in the anterior periaqueductal region, unchanged areas of susceptibility effect and enhancement in the posterior right temporal and frontal periventricular regions, and unchanged punctate foci of susceptibility effect in the bilateral anterior frontal lobe periventricular regions may represent treated lymphoma. 3. A nonspecific punctate focus of enhancement in the right insula is less conspicuous. 4. Post-treatment findings with cerebral white matter abnormality and brain volume loss.