 Diffusion weighted images are again compromised due to extensive ferromagnetic artifact from postoperative changes of left temporal craniotomy and aneurysm clip in the left paramedian sellar region. The artifact obscures the midbrain, left antrum, right basal ganglia and portions of bilateral anterior frontal lobes along the floor of anterior cranial fossa. Beyond the region of artifact there is no abnormal restricted diffusion. Extensive blooming artifact obscures full visualization on SWI images. Within these limitations there is no evidence of acute hemorrhage. No abnormal contrast enhancement is noted on postcontrast images.The previous well demarcated focus of increased signal intensity in the left basal ganglia is again seen and not significantly changed. The abnormal T2/flair signal representing encephalomalacia in the left anterior temporal lobe is also not significantly changed.Redemonstrated is small varying sized foci of flair and T2 increased signal intensity in the periventricular and subcortical white matter of bilateral cerebral hemispheres and minimally in bilateral basal ganglia, which are believed to represent chronic small vessel ischemic strokes.Interval resolution of the mixed-signal intensity blood under the left sided craniotomy flap with expected postsurgical changes.
1.Postsurgical changes from a left temporal craniotomy and aneurysm clipping in the left paramedian sellar region.2.No significant change in the periventricular and subcortical white matter disease.3.A subdural hematoma has resolved.4.There is a small focus of left temporal lobe encephalomalacia present.