Reason: to r/o vp shunt malfunctioning History: pineal tumor, progressing, vp shunt in situ Suboccipital midline craniectomy is redemonstrated. Extensive bilateral cerebellar and left occipital cortical calcification is again identified and with no interval change. Finding are secondary to post therapy changes.There is filling of the subarachnoid space in the posterior fossa with high attenuation material which extends into the basal cistern. This is noted in the subarachnoid space at the level of foramen magnum, ambient cistern, prepontine cistern, and cerebellar pontine angles. These findings are believed to represent worsening of previously noted extensive pachymeningitis and possible carcinomatosis. There is suggestion of mass effect on the medulla secondary to above findings. Further follow-up with a dedicated MRI examination will significantly better characterize the above findings.Unchanged course and position of right lateral ventricular catheter. The shunt appears to partially traverse the right lateral ventricle. No change in the normal size of ventricular system since prior study. Diffuse low attenuation of the bilateral hemispheric white matter is stable since prior exam. This finding is believed to represent post therapy changes and surgical intervention for placement of multiple prior ventricular catheter placement.There is no hemorrhage, edema, mass effect or midline shift. The calvarium and soft tissues of the scalp are within normal limits. Air-fluid levels within the maxillary sinuses bilaterally. The mastoid air cells are clear.
1.High attenuation content within the subarachnoid space in the posterior cranial fossa with extension into the suprasellar cistern. Findings are believed to represent interval worsening of patient's known extensive pachymeningitis and possible carcinomatosis.2.Further evaluation with an infused MRI examination is recommended.3.Stable size of shunted supratentorial ventricular system.4.Stable extensive bihemispheric white matter low-attenuation believed to represent post therapy changes.5.Therapy related calcification within the cerebellum bilaterally and left occipital cortex with minimal interval worsening.