69-year-old male with worsening cognitive impairment likely secondary to cerebral changes after right MCA aneurysm repair and subdural hematoma. Postoperative changes of right frontotemporal craniotomy for MCA aneurysm clipping again seen. Susceptibility artifact limits evaluation of the brain parenchyma adjacent to the clip. There are several scattered foci of T2/FLAIR hyperintensity in the bilateral periventricular and subcortical white matter which are nonspecific but compatible with mild chronic small vessel ischemic changes and stable to minimally worse since 5/3/2013. There is no intracranial mass or mass effect. There is no evidence of acute ischemia or hemorrhage. No extra-axial collections. There is prominence of the right temporal horn which is at least partly related to the slightly greater volume loss in the right temporal lobe, but unchanged since 5/3/2013. There is volume loss involving the hippocampi which does not appear to be grossly disproportional to the generalized mild brain parenchymal volume loss.There is opacification of the mastoid air cells, right worse than left. Paranasal sinuses demonstrate minimal scattered opacification.
1. No significant change since prior MRI brain dated 5/3/2013 including postoperative changes related to right MCA aneurysm clipping as well as fairly mild chronic small vessel ischemic changes. 2. No significant change in asymmetric enlargement of the right temporal horn which is at least in part related to volume loss.