Possible visual deficit, increased headaches. There is a small subdural hematoma along the right cerebral convexity which measures up to 5 mm in thickness, previously approximately 3 mm. There is no significant mass effect. The ventricles and sulci are slightly larger compared to 5/15/2015 likely indicating resolution of previously seen mild cerebral edema. Blood products are noted within the left inferior frontal lobe and medial cerebellar hemispheres on the susceptibility sensitive sequence.Subtle T2/FLAIR hyperintensity again seen along the lateral orbital frontal gyrus, slightly less prominent than before. Previously seen subtle T2 signal involving the medial cerebellar hemispheres also less prominent. No restricted diffusion to suggest acute ischemia. No intracranial mass or mass-effect. The ventricles are within normal limits in size and configuration. Brain parenchyma is otherwise unremarkable. Major flow-voids are preserved. Diffuse paranasal sinus opacification is again seen but appears improved since 5/15/2015. Please note left orbital fractures are better seen on prior CT.Postcontrast demonstrate diffuse dural enhancement which may be reactive to the subdural blood products.Dedicated images of the orbits demonstrate no abnormal signal within the optic nerves or evidence of mass effect. No retrobulbar hematoma. Minimal edema is seen involving the left periorbital soft tissues. There is subtle asymmetrically increased T2 signal and enhancement involving the left superior and lateral recti musculature which may represent minimal intraorbital soft tissue edema (for example coronal STIR image 14). No discrete intraorbital hematoma is appreciated.
1. Compared to 5/15/2015, there is mild increase in size of small subdural hematoma along the right cerebral convexity measuring up to 5 mm, previously 3mm, but without significant mass effect. Finding is at least in part related to decreased tamponade effect from previously seen mild cerebral edema which has since improved. Diffuse dural enhancement is noted which may be reactive to the subdural collection.2. Evolution of small foci of hemorrhagic contusions involving the left orbitofrontal gyri with decrease in mild associated edema. Minimal blood products are also noted involving the medial bilateral cerebellar hemispheres with decrease in associated edema seen previously. 3. Left orbital fractures are better seen on prior CT. No appreciable T2 signal/edema or enhancement involving the optic nerves or chiasm is appreciated. Minimal left intra-orbital soft tissue edema as described above. No discrete intra-orbital hematoma.