46 years, Female, evaluate for stroke or abscess. Additional history per chart: "history of Chiari malformation S/P decompression, pseudotumor cerebri, VPS and LPS (s/p removal), CNS infection, L4-S1 fusion surgery, PFO s/p repair and a-flutter with ablation (2012) who presented to ED after an episode of LOC and seizure-like activity". Again seen are postsurgical changes related to Chiari decompression including suboccipital craniectomy and C1 laminectomy. As seen on recent CT, there is recent placement of a left transparietal catheter which courses in the left parietal lobe, extending across the cingulate gyrus and terminating slightly to the right of the midline. Intraventricular course is not demonstrated as noted on recent CT. There is hyperintense FLAIR signal compatible with vasogenic edema involving the left parietal lobe surrounding the catheter which appears new since prior. Also noted is small fluid immediately surrounding the intracranial portion of the catheter with minimal enhancement. There is also a right frontal lobe linear tract related to prior ventriculostomy with T2 hyperintensity in this region compatible with gliosis. Susceptibility artifact related to the external portion of the left transparietal shunt catheter limits evaluation of the adjacent parenchyma. No new restricted diffusion or susceptibility is appreciated. Minimal chronic blood products are seen along the prior right transfrontal ventriculostomy tract. No abnormal parenchymal or meningeal enhancement is appreciated. Small developmental venous anomaly in the right cerebellum incidentally noted. Major arterial and venous structures appear patent.Previously seen left superior orbital extraconal collection has essentially resolved, with minimal T2 hyperintensity within this region which may represent postsurgical change.
1. No evidence of intracranial abscess or empyema. No definite evidence of infarct or acute hemorrhage, within the limitations of susceptibility artifact in the left parietotemporal region.2. Left transparietal shunt catheter courses superior to the lateral ventricles as noted on recent CT. There is interval increase in vasogenic edema in the left transparietal lobe which appears new since CT dated 1/27/2016. There is also fluid immediately adjacent to the intracranial portion of the catheter with minimal enhancement. The etiology of these findings is uncertain but possibilities include infection as well as venous injury.