Clinical question: Evaluate for shunt malfunction. Signs and symptoms: Headache. Pre-and post-enhanced brain MRI:Immediate images are severely compromised due to extensive metallic artifact overlapping the right hemisphere. Beyond the artifact there is no evidence of restricted diffusion.Stable expected postoperative changes of Chiari decompression without change.Flair and T2 weighted images are also partially obscured secondary to metallic artifact on the right side. Beyond the artifact examination demonstrate shunt the normal size supratentorial ventricular system without interval change since prior exam. A right frontal approach ventricular catheter with the tip in the right frontal horn at the level of foramen of Monro is noted. There is mild interval change in the position of the catheter since prior exam. The tip of the catheter is a slight disorder into the right frontal horn since prior study.The cerebral cortex, cortical sulci, ventricular system, CSF spaces and brain myelination is within normal.Signal void of major intracranial arterial branches are identified.The signal intensity of intracranial venous sinuses are within normal.Post-enhanced images were also extensively obscured by metallic artifact obscuring a large segment right hemisphere. Beyond the artifact there is no evidence of abnormal parenchymal, leptomeningeal or calvarium enhancement.Unremarkable images through the orbits and including axial fat sat post enhanced series.Unremarkable signal intensity of paranasal sinuses, mastoid air cells and middle ear cavities.
1.Examination is degraded due to metallic hardware artifact resulting in varying degree of obscuration of right hemisphere as detailed.2.Stable normal size of ventricular system. Right frontal approach ventricular catheter with the tip in the right frontal horn as detailed.3.Unremarkable pre-and post enhanced brain MRI otherwise.