30-year-old with history of gunshot wound to the left side of the head with increased tone in spasticity with question of previous stroke and question of new seizure. A bullet or structural abnormality left in the brain. There is no evidence of intracranial hemorrhage, mass or edema. Large left-sided encephalomalacia throughout the frontal parietal and temporal lobes with ex vacuo dilatation of the adjacent ventricles. Patient appears to be status post craniotomy. No acute cortical stroke identified. If there is clinical concern for acute ischemia, an MRI may be considered.The basal cisterns are normal in size and configuration.With exception of postsurgical craniotomy the calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.No evidence of retained intracranial metallic fragments.
1. Left frontoparietal and temporal extensive encephalomalacia without evidence of acute ischemia. If there is clinical concern for acute ischemia, an MRI may be considered.2. No evidence of retained intracranial metallic fragments.