Clinical question: Evaluate for intracranial bleed and or obstructive hydrocephalus. No schizencephaly. Signs and symptoms: Emesis, irritability, I and head deviation to the left. CT of brain without infusion:There is significant interval increase in the size of fourth ventricle since prior examination. Prior MRI demonstrated normal size of the fourth ventricle. On the current exam expanded fourth ventricle upright mass effect on the pons and causes significant deformity of the quadrigeminal plate and appears to extend across the tentorium into the supra-tentorial space. Significant congenital deformity of bilateral schizencephaly with extensive extra axial CSF collection is again identified. There is bilateral larger extension of CSF into the extra-axial space with associated mass effect on the brain parenchyma since prior study.No evidence of hemorrhage is detected. Linear very high density material along the ependymal lining of the left temporal horn and occipital horn of the lateral ventricle are present calcification. These findings were noted on prior exam.
1.Significant interval enlargement of fourth ventricle since prior study.2.Larger amount of CSF in the extra-axial space with further increased mass effect on the brain parenchyma.3.Microcalcifications along the ependymal lining of the left lateral ventricle stable since prior study.4.No evidence of intracranial hemorrhage as clinically questioned.