Right sided gaze preference, fever, and lethargy. MRI: There is a right transparietal ventricular shunt catheter that terminates in the brain parenchyma adjacent to the left lateral ventricle. The imaged portions of the catheter appear to be intact. There has been decrease in size of the bilateral supratentorial small subdural fluid collections since August 2014, but concomitant slight increase in size of the third and lateral ventricles. There is gyriform T2 hyperintensity and swelling in the right posterior temporal lobe. There are scattered foci of punctate susceptibility effect in the bilateral cerebral hemispheres. There is a 5 mm wide left inferior parietal convexity mass. There is predominantly periventricular bilateral cerebral white matter T2 hyperintensity. There are punctate foci of encephalomalacia in the right caudothalamic groove region and corona radiata. There is no midline shift or herniation. The orbits, skull, paranasal sinuses, and scalp soft tissues appear unchanged, including postoperative findings related to biparietal craniotomy.MRA: There is no evidence of significant steno-occlusive lesions in the head and neck arteries. There is no evidence of saccular cerebral aneurysms.
1. Decrease in size of the bilateral supratentorial small subdural fluid collections since August 2014 with concomitant slight increase in size of the shunted third and lateral ventricles, which may be compensatory in nature. 2. Gyriform edema in the right posterior temporal lobe may represent recent infarction or an infectious process. Assessment is limited by the lack of intravenous contrast and artifact related to the overlying reservoir.3. Small probable meningioma along the left inferior parietal convexity.4. Punctate foci of encephalomalacia in the right caudothalamic groove region and corona radiata likely represent chronic lacunar infarcts. 5. Scattered foci of punctate susceptibility effect in the bilateral cerebral hemispheres may represent chronic microhemorrhages, septic emboli, or cavernous malformations.6. No evidence of significant steno-occlusive lesions in the head and neck arteries. 