Headache and neck pain. Evaluate for signs of infection. History of spina bifida, tethered cord and pseudomeningocele. Also history of right suboccipital shunt placement. MRI brain:There is redemonstration of an 8 mm diameter lesion centered in the left putaminal and of the basal ganglia. It has not changed in diameter compared to the prior exam, however, has enlarged since the 3/2/2009 exam. Lipid density subependymal punctate foci of T1 signal hyperintensity are redemonstrated along the lateral ventricles and within the left sylvian fissure and are not significantly changed from the previous exam. The ventricles and basal cisterns are unchanged in size and configuration. Enhancement is noted within the soft tissues of the prior right suboccipital ventriculostomy but no fluid collections are evident. This could represent phlegmon in the appropriate clinical setting but could also represent aseptic postsurgical reaction. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.MRI cervical spine:Limited study secondary to motion. Within these limitations the craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. Alignment is maintained. Bone marrow signal is within normal limits. The cervical spinal cord has normal signal characteristics and overall morphology. No significant neuroforaminal or spinal canal stenosis. Paraspinous soft tissue structures appear within normal limits.
Enhancement within the soft tissues of the prior right suboccipital ventriculostomy surgical site could represent phlegmon in the appropriate clinical setting but could also represent aseptic postsurgical reaction. No loculated fluid collection is noted.