Findings
- Surgical changes of right hemicraniectomy with surgical staples and surgical drain in place. Expected trace postsurgical extra-axial hemorrhage
- Large hypoattenuating areas with loss of gray-white differentiation involving nearly the entire right cerebral hemisphere
- Right to left midline shift with subfalcine herniation and right uncal herniation resulting in effacement of the suprasellar cistern
- Effacement of the right lateral ventricle and enlargement of the atrium and temporal horn of the left lateral ventricle with confluent hypoattenuating in the left lateral periventricular white matter
- Hyperattenuating appearance of the proximal right MCA
- Partially imaged endotracheal tube
Diagnosis
Post-infarct edema with herniation and ventricular entrapment
Sample Report
Surgical changes of right hemicraniectomy with surgical staples and surgical drain in place. Expected trace postsurgical extra-axial hemorrhage.
Large hypoattenuating areas with loss of gray-white differentiation involving nearly the entire right cerebral hemisphere consistent with cytotoxic edema.
No evidence for intraparenchymal hemorrhagic conversion.
Resultant right to left midline shift with subfalcine herniation and right uncal herniation resulting in effacement of the suprasellar cistern. No tonsillar herniation.
Effacement of the right lateral ventricle and enlargement of the atrium and temporal horn of the left lateral ventricle with confluent hypodensity in the left lateral periventricular white matter consistent with transependymal flow of CSF. Findings are concerning for ventricular entrapment with obstructive hydrocephalus.
Hyperattenuating appearance of the proximal right MCA, concerning for thrombosis.
Discussion