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CT Head Subdural Hematoma

FINDINGS: There are bilateral holohemispheric hypodense collections with superimposed hyperdense right holohemispheric crescentic density. There is also hyperdense fluid in the subdural space anterior to the left frontal convexity and extending into the falx cerebri. Small right temporal contusion is noted superior to the mastoid air cells. There is a ventriculoperitoneal shunt that passes through the right posterior frontal calvarium, passes through the right frontal lobe, and terminates in the frontal horn of the right lateral ventricle. There is no midline shift, hydrocephalus, or herniation. There is global volume loss with concomitantly increased intra and extra-axial CSF-containing spaces. Periventricular white matter chronic microvascular ischemic changes are noted. Dense atherosclerotic calcifications are present. There is no skull fracture. There is patchy opacification of the ethmoid air cells and polypoid mucosal thickening of the left maxillary sinus.

1. Acute on chronic holohemispheric subdural hematomas without midline shift, hydrocephalus, or herniation.
2. Probable right temporal contusion. (13163734)
A 1.2 cm thick extra-axial curvilinear fluid density is present along the left frontal lobe with a hematocrit level. There is approximately 9 mm of associated midline shift. The contralateral ambient cistern is poorly visualized. Underlying the region of the left occipital craniotomy is a foci of hypodensity with linear streaks of increased density that is not significantly changed since the comparison MRI. The remainder of the brain parenchyma is normal in density. The visualized sinuses are normal.

There is mild increase in enhancement along the previously described linear streaks in the left occiput. There are no other areas of abnormal enhancement. There are no visualized aneurysms. A focal area of fluid density is present along the right frontal lobe (Series 6 Images 18-20) that is not visualized on the non- contrast images and may represent prominent CSF space versus artifact.

1. Acute on chronic left subdural hematoma, may be one week of age, with 9mm of midline shift. Currently there is no rim of enhancement to suggest empyema or infection.
2. Linear density in the left occiput with enhancement that is not changed since the comparison MRI and likely represents post operative findings status post left occiput meningioma resection.