Reason: follow-up: FHLH s/p multiple areas of ischemic necrosis at diagnosis in 2007; currently stable spastic quadriparesis and global delay and seizures History: spastic quadriparesis and global delay and seizures There is redemonstration of extensive loss of parenchymal volume with accompanying signal FLAIR signal abnormality consistent with gliosis, most conspicuous in the hemispheric white matter, and in some locations extending through the cortex (for example in the left perirolandic region). Signal abnormality and volume loss involves the brainstem and cerebellar hemispheres to a lesser extent. Ventricles remain enlarged related to the volume loss more pronounced in the bilateral frontal and temporal lobes. No findings to suggest hydrocephalus. These findings are unchanged from the prior examination and consistent with sequela of remote insult, possibly due to reported hemophagocytic disorder.No new parenchymal signal abnormality is appreciated compared to 10/5/2011. There is diffuse thinning of the corpus callosum which may be related to Wallerian degeneration but unchanged from prior. There is no intracranial mass effect, midline shift, or basal cistern effacement. There is no diffusion abnormality. There is no evidence of intracranial hemorrhage or extra-axial collection. There is no abnormal enhancement following injection of intravenous contrast.The major intracranial flow-voids are present. Visualized orbital contents are unremarkable. There is mild opacification involving the right sphenoid sinus as well as small right maxillary mucosal retention cyst.
Sequela of extensive prior insult including severe supratentorial and to a lesser degree infratentorial parenchymal volume loss but remains unchanged since 10/5/2011. No new parenchymal lesion or area of abnormal enhancement. 