77 years, Female, pneumocephalus, evaluate for CSF leak. There is extensive susceptibility effect related to pneumocephalus scattered throughout the brain, particularly along the right frontal convexity. There is mass effect related to the pneumocephalus on the right frontal lobe with sulcal effacement and mild mass effect on the right lateral ventricle. There is subfalcine herniation and midline shift measuring 6 mm at the level of the foramen of Monro. No hydrocephalus.Extensive foci of susceptibility limit evaluation for ischemia however no evidence of large vascular distribution infarct or large parenchymal hemorrhage is evident. There is a small extra-axial collection along the right cerebral convexity extending along the right tentorium.Diffuse global parenchymal volume loss is noted. Scattered foci of T2/FLAIR hyperintensity in the brain are nonspecific but compatible with mild chronic small vessel ischemic disease.There are subtle foci of air and T2 hyperintensity along the anterior skull base (coronal T2 images 10 and 11) which are potentially sites of CSF leak, however, the motion degradation especially on the relatively higher-resolution sequences limits identification of exact site of leak.
Extensive pneumocephalus with mass effect on the right frontal convexity and mild leftward midline shift.There are subtle foci of asymmetric fluid and air at the level of the right fovea ethmoidalis and cribriform plate which are potential sites of CSF leak (coronal T2 images 10 and 11); however motion degradation limits evaluation for the exact site of leak. Suggest high resolution MRI of the anterior skull base and/or high-resolution CT of this region to identify a bony defect. No encephalocele is evident. Small right-sided subdural collection without associated mass effect. 