Reason: s/p craniotomy History: ha Since the previous examination the patient has undergone frontal craniotomy for removal of a right frontal extra-axial mass. At the surgical bed there are blood products present in the subarachnoid space and gyral surface of the right lobe. There is T2/FLAIR signal hyperintensity within the adjacent right frontal lobe and to a lesser degree left frontal lobe. There is some diffusion restriction present along the right frontal lobe as well as the anterior aspect of the cingulate gyri in the body of the corpus callosum.There is a small right sided parafalcine lesion present adjacent to the right paracentral lobule measuring 30 x 10 mm axial dimensions. It is suspected to represent some residual neoplasm.There is a hemorrhagic lesion present in the right frontal subcortical white matter which was previously present but more conspicuous on current exam. It measures approximately 8 mm in diameter.There is soft tissue swelling along the scalp tissues at the site of surgery .There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. FLAIR and T2 hyperintensities are also present in the brain stem.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.
1.Since the prior exam the patient has undergone resection of a extra-axial mass adjacent to the right frontal lobe. There is only a small residual right parafalcine component present adjacent to the right paracentral lobule. There are associated postoperative changes present with blood products in the surgical bed and swelling along the scalp tissues. There are also blood products in the adjacent extra-axial spaces at the surgical bed.2.Foci of diffusion restriction present along cingulate gyri, corpus callosum and right frontal lobe are present. The possibility that this is ischemia related cannot be excluded.3.There is remote traction of a small right frontal lobe hemorrhage.4.There are periventricular and subcortical white matter changes of a mild degree as well as minor brainstem lesions which are nonspecific. At this age they are most likely vascular related. 