31 year old female with nausea/vomiting, headache, fatigue, history of VP shunt placed 2/02/12 currently on intrathecal chemotherapy for history of breast cancer with leptomeningeal/thoracic metastases. Shunt unable to be opened status post chemotherapy on 2/22/12. There is redemonstration of a right frontal approach VP shunt terminating in the region of the left foramen of Monro, unchanged in position when compared to the previous study. Interval enlargement of the lateral ventricles bilaterally and the third ventricle. The frontal horn of the left lateral ventricle measures 16 mm (15; series 4), previously 13 mm. The third ventricle measures 10 mm, previously 9 mm. There is no evidence of transependymal CSF flow. The sulci are normal in size and configuration. There is no midline shift or basal cistern effacement.There is no evidence of acute intracranial hemorrhage, extra-axial fluid collection, mass or edema. There is preservation of the gray-white matter interface. There is no evidence of acute territorial ischemia. The leptomeningeal metastatic disease seen on the prior MRI is not resolved on this noncontrast CT.The calvaria and skull base are radiographically normal. Previously seen swelling over the right scalp has subsided. The visualized mastoid air cells and paranasal sinuses are clear apart from some debris within the sphenoid sinuses, unchanged.
Stable positioning of right sided VP shunt with mild interval enlargement of the lateral ventricles and third ventricle. No transependymal CSF resorption, acute intracranial hemorrhage, or mass effect.