Diagnosis: Other injury of unspecified body region Accidental discharge from unspecified firearms or gun, initial encounter Unspecified open wound of unspecified part of head, initial encounter Accidental discharge from unspecified firearms or gun, initial encounterClinical question: Evaluate for interval changeSigns and Symptoms: GSW to head The patient is status post recent suboccipital craniotomy.There is heterogeneous diffusion restriction throughout the cerebellum, brainstem globus pallidus on a and portions of the thalami associated with blood products within the cerebellar hemispheres and swelling of the cerebellar hemispheres. Some blood products also present in the brainstem and medial thalami. The brainstem is flattened against the clivus and stretched superiorly.. There is a superior transtentorial herniation of posterior fossa contents above the tentorial notch. The third ventricle, thalami and basal ganglia are displaced superiorly. The brainstem is flattened against the clivus and there is near obliteration of the fourth ventricle. The inferior aspect of the right cerebellar hemisphere appears less affected. The rest of the cerebellum has abnormal signal throughout. The brainstem has abnormal signal on the left side more than the right. There is some herniation of intracranial contents into the craniotomy defect. There are subdural hematomas present adjacent to the occipital lobes bilaterally. The one on the left is larger than the one in the right. One of the left measures 6 mm in thickness whereas the one on the right measures approximately 4 mm in thickness.The flow voids of the basilar artery and vertebral arteries are small. The internal cerebral veins are displaced superiorly. The flow void of the vena Galen appears compressed. The straight sinus flow void is identified and also appears somewhat compressed. The flow-void of the right and left sigmoid sinus are both identified.There is leptomeningeal enhancement present in the posterior fossa.A ventriculostomy tube courses to the right frontal lobe into the right lateral ventricle with tip in the region of foramen of Monro.The visualized portions of the paranasal sinuses demonstrate mucosal thickening. The visualized portions of the mastoid air cells are opacified. The visualized portions of the orbits are intact.
1.Marked cerebellar swelling associated with infarctions and hemorrhage and superior transtentorial herniation. Additional infarcts are present in the medial thalami and globus pallidi. There is associated compression of the brainstem and near obliteration of the fourth ventricle. The inferior aspect of the right cerebellar hemisphere appears less affected.2.There are subdural hematomas adjacent to the occipital lobes bilaterally.3.The patient is status post suboccipital craniotomy. There is some herniation of intracranial contents into the craniotomy defect4.A leptomeningeal pattern of enhancement could be inflammatory in nature or it could also be reaction to subarachnoid blood products. The possibility of meningitis cannot be excluded on the basis of this exam.5.A ventriculostomy tube is in place. The ventricles are not particularly dilated.