Female, 35 years old, with altered mental status, left neglect and right eye deviation. No evidence of restricted diffusion is seen. No edema, mass effect or pathologic intracranial enhancement is observed. A defect in the floor of the right middle cranial fossa allows passage of presumed meninges and perhaps a small amount of brain parenchyma through the sphenoid region into the posterior right nasal cavity. This cephalocele is fluid containing as on the prior exam. New fluid opacification of the left sphenoid sinus is seen even when compared to prior exams from 11/3. The fluid signal does suppress on FLAIR images. Evidence of endoscopic sinus surgery is redemonstrated.No evidence of intracranial hemorrhage is seen. Apart from the cephalocele, no additional abnormal extra-axial collections are detected. Ventricular size and morphology remain within normal limits.
1.No new or acute findings are seen which would account for the patient's symptoms.2.Findings are redemonstrated compatible with a cephalocele. Although this is a chronic finding, it could potentially represent a source of seizure activity if seizures are in the clinical differential.3.Relatively abrupt fluid opacification of the left sphenoid sinus is seen as this finding was not present on examinations from 11/03/16. The fluid signal suppresses on FLAIR images which suggests that its consistency is close to water. While this could simply be inflammatory in nature, the possibility of a CSF leak can't be considered as well.