Female, 28 years old, status post Rickham removal with headache. Findings are redemonstrated compatible with extensive prior right-sided surgery and right hemispherectomy. The previously seen right parietal approach drainage catheter has been removed. The extra-axial fluid collection within the right-sided craniectomy defect contains air but is otherwise unchanged.Right-sided intracranial fluid involving the hemispherectomy defect and likely contiguous with the ventricular system is unchanged. Multiple left-sided cerebral cysts are redemonstrated. The largest cyst, within the medial left temporal lobe, is not significantly changed. Posterior to this, several smaller cysts are also redemonstrated. One of these, which may have been drained by the previous catheter, seem to have slightly increased in size now measuring up to 18 mm in diameter, previously 14 mm.When compared to the prior MRI, T2 hyperintensity within the left cerebral white matter has increased. In addition, there is new parenchymal hyperintensity involving the left thalamus and cerebral peduncle. No diffusion restriction is seen. No acute hemorrhage is suspected.
1.Extensive postoperative alterations are redemonstrated including right-sided craniotomy/craniectomy and right hemispherectomy.2.Interval removal of a right parietal approach drainage catheter. One of the left-sided cysts which may have been drained by the catheter has slightly increased in size. Other cysts do not appear to have changed.3.When comparison is made to the prior MRI from 09/29/16, there has been an increase in the extensiveness of T2 signal abnormality involving the left cerebral white matter. New abnormal signal perhaps representing edema is also evident within the left thalamus and cerebral peduncle. The nature of this signal change is uncertain, though it does not appear to be related to acute ischemia as there is no restricted diffusion. Edema related to compression, or perhaps adhesive stretching and traction, would be considerations. An inflammatory or infectious process would also need to be considered.