Diagnosis: Subdural hemorrhageClinical question: past history of SDH with subarachnoid blood - please assessSigns and Symptoms: stable The CSF spaces are appropriate for the patient's stated age with no midline shift. No foci of diffusion restriction are appreciated intracranially.A focus of encephalomalacia is present along the left frontal lobe orbital gyrus. This is associated with signal change on susceptibility weighted imaging. This was not present on the exam of 8/23/2013. There is an intraparenchymal hemorrhage in this location identified on the 10/18/2014 head CT.There are foci of T2 and FLAIR signal hyperintensity present in the right temporal lobe centered at the right superior temporal gyrus, right orbital gyrus extending to the right inferior frontal gyrus and the right some central lobule. There is evidence of prior subarachnoid hemorrhage, small intraparenchymal hemorrhage and subdural hemorrhage adjacent to these lesions on the 10/18/2014 CT of the head exam.There is pachymeningeal thickening present adjacent to the right parietal lobe.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. These are unchanged since the prior examNo abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.There is hypertrophy of the cruciate ligaments present which appears to mildly progressed since the prior exam..
1.Since the previous examination the patient has developed a focus of encephalomalacia in the left frontal lobe suspected to represent sequela of prior traumatic brain injury.2.There are multiple lesions involving gray and white matter at the right frontal lobe, right temporal lobe and right some central lobule. These could potentially the sequela of prior subarachnoid, intraparenchymal and subdural hemorrhage.3.Right sided pachymeningeal thickening adjacent to the right parietal lobe is nonspecific but can be related to sequela of prior subdural hematoma or infection . It is conceivable that similar thickening may be seen with granulomatous disorder and lymphoma depending on the clinical history.4.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related. 