Neuro_MR_Brain: 29 F, history of VP shunt and progressive neurologic decline.

MRI BRAIN WITH AND WITHOUT CONTRAST:

CLINICAL HISTORY: 29-year-old woman with history of VP shunt, recent methamphetamine use and history of alcohol abuse, presenting with 2 months of progressive symptoms including stiffness, loss of function, nonambulatory, poorly interactive, and incontinent. Per report, normal outside MRIs.

FINDINGS:

Exam degraded by susceptibility artifact from shunt catheter, likely a programmable shunt.

Parenchyma: No evidence of acute infarct, hemorrhage, mass effect, or abnormal enhancement. Right frontal approach ventricular shunt catheter traverses the foramen of Monro and terminates in the region of the genu of the left internal capsule. Gliosis seen along the catheter tract. Small cavity with hemosiderin ring in the right middle frontal gyrus adjacent to catheter tract compatible with sequela of old trauma or hemorrhage. T2 signal abnormality in the superior and middle aspect of the posterior body of the corpus callosum, most likely due to decompression of hydrocephalus after shunting. Additional punctate T2/FLAIR hyperintense focus in the left posterior frontal subcortical white matter (image 17:20), nonspecific.

Ventricles and extra-axial spaces: Ventricles are decompressed.

Orbits: Normal.

Visualized paranasal sinuses: Clear.

Mastoid air cells: Clear.

Bones: Normal.

Additional comment: None.

IMPRESSION:

1. No evidence of acute infarct, hemorrhage, mass effect, or abnormal enhancement.

2. Right frontal approach ventricular catheter terminates in the region of the left genu of the internal capsule, with catheter sideholes likely within frontal horn of right lateral ventricle. Ventricles are decompressed. T2 signal abnormality in the posterior body of the corpus callosum, may be related to decompression of hydrocephalus after shunt placement. Comparison with prior outside imaging may be useful to determine the stability of these findings.

(Callosal signal after decompression)