Altered mental status. Evaluate for a cerebral abscess. Status post evacuation 11/22/2016. Additional EMR indicates patient is undergoing a seizure workup. The exam is limited along the right convexity and adjacent scalp secondary to artifact from a ventriculoperitoneal shunt device. The right sided predominantly T1 hyperintense subdural collection is slightly smaller in size, measuring 16 mm in maximal thickness. The midline shift has improved from 5 mm down to 2 mm. Susceptibility and diffusion weighted images are limited in the presence of a right sided ventriculoperitoneal shunt device positioned under the scalp but there appear to be blood products within the collection. There is evidence of a right parietal burr hole and an intraparenchymal tract measuring up to 20 mm with T1 hyperintense fluid and restricted diffusion in the right parietal brain parenchyma, as well as mild surrounding enhancement. There is susceptibility abnormality in this region as well, indicating the presence blood products. There is extensive surrounding T2 hyperintensity. There is avid diffuse enhancement and thickening of the pachymeninges which also extends to the contralateral frontal region. There is a 2 mm thick subdural collection along the posterior left temporal lobe convexity. The right frontal approach ventriculostomy catheter is unchanged in position with the tip in the frontal horn of the right lateral ventricle. The right lateral ventricle has slightly less effacement compared to the prior exam. There is diffuse T2 hyperintensity in the right hippocampus. There is no evidence of territorial infarction. The major cerebral flow voids are intact. There is a left maxillary sinus mucous retention cyst.
1.Decrease in size of the subacute right cerebral convexity subdural fluid collection with improvement in the midline shift and slight improvement in the right lateral ventricular effacement. 2.Avid diffuse pachymeningeal enhancement in the right cerebral hemisphere with extension to the contralateral frontal region is nonspecific and be reactive or related to superimposed. 3.A surgical defect in the right parietal lobe with surrounding edema may represent a subacute hemorrhagic lesion perhaps with superimposed infection and associated cerebritis.4.A small left temporal convexity subdural collection may represent addition hemorrhage or perhaps an empyema.5.Edema in the right hippocampus is likely related to seizure activity.