 There are artifacts from the right parietal approach shunt valve which limits interpretation of the diffusion and the susceptibility images.There is redemonstration of ventriculostomy catheter with the left frontal horn, revised since prior MR. The ventricles are slitlike and decompressed. Compared to the previous CT, there is grossly stable fourth ventricular dilatation, measuring approximately 28 x 19 mm in transaxial view. The right foreman of Luschka is widened.There is dysmorphic appearance of the brain. There is diffuse white matter volume loss with also prominence of the sulci.In the visualized portion of the susceptibility images, low signal is seen in the left thalamus and in the right centrum semiovale. The left thalamic cyst that was seen in the previous study is still present but has significantly decreased in size from 22 mm to 7 mm CC. There is greater extent of the T2/FLAIR high signal in the periventricular white matter with involvement of the centrum semiovale.The falx is dysplastic and there is a focal leftward herniation of the medial posterior right frontal lobe through the falcine deficiency.There is an abnormal cleft perhaps along the spectrum of schizencephaly of the left frontoparietal region, versus severe gliosis and loss of white matter with abnormal sulcation. However, no definite abnormal gyral thickening or polymicrogyria is detected.The anterior body and the genu of the corpus callosum are seen with small rostrum. The posterior body and splenium are not as well visualized, suggesting hypoplasia.
1. Persistent slitlike lateral and third ventricles with significantly dilated fourth ventricle and widened right foramen of Luschka, unchanged from the previous CT. Stable right parietal approach ventriculostomy catheter.2. The left thalamic cyst has significant decreased in size, likely in communication with the lateral ventricles.3. Greater extent of the T2/FLAIR high signal in the periventricular and deep white matter, which may relate to areas of gliosis perhaps relating to underlying periventricular leukomalacia. Extensive volume loss, especially of white matter.4. Dysplastic anterior falx with leftward herniation of the right medial posterior frontal lobe.5. Hypoplastic posterior corpus callosum.6. Abnormal deep sulcus along left frontoparietal region, with questionable schizencephaly spectrum abnormality vs. gliosis and abnormal sulcation. No definite migrational abnormality appreciated.