Neuro_CT_head: 28 F, intracranial lesion and VP shunt.

CT HEAD: 

 

CLINICAL HISTORY: 28-year-old female with somewhat vague history of possible remote intraventricular hemorrhage status post drainage and shunt placement in Mexico, status post- revision at least once. Questionable history of cysticercosis. Currently complains of nausea, vomiting, headache. 

 

FINDINGS: 

 

On the non contrast images, a ventricular catheter enters the left parietal skull, passes through anterolateral portion of the occipital horn of the lateral ventricle, courses anteriorly and inferiorly traversing the septum pellucidum just above the third ventricle, and terminates at the medial base of the frontal horn of the right lateral ventricle. No other skull wall defects are noted. 

 

The ventricles are quite large. The left greater than right temporal horns are prominent. The frontal horns are bowed outward. The third ventricle is enlarged and bowed outward. The fourth ventricle is slightly enlarged as well. The periventricular white matter is of normal density. Near the vertex, the sulci are poorly seen. The quadrigeminal plate cistern is seen, but the suprasellar cistern seems to be compressed by the dilated third ventricle. 

 

In the body of the left lateral ventricle, there is a lobulated and excrescent mass contiguous with the lateral margin of the ventricle. The mass measures approximately 2.7 x 1.6 cm. The rim enhances with contrast. The ventricular catheter passes adjacent to this mass. Adjacent superior white matter in the centrum semiovale is hypodense. 

 

Hypodensity of the left medial anterior temporal region is seen in the gray and white matter. 

 

There are no intraaxial or extraaxial fluid collections. There is no midline shift. The visualized portions of the sinuses are clear. 

 

 

IMPRESSION: 

 

1. Left parietal ventricular catheter is seen.

2. Significantly enlarged ventricular system. No signs of transependymal flow, with sulci near to the vertex not easily visible. Unable to judge acuity of ventriculomegaly. Recommend comparison with prior scans.

3. Rim-enhancing mass seen in lateral margin of body of the left lateral ventricle. Differential includes inflammatory reaction to prior hematoma versus neoplasia. Cysticercosis is unlikely. MRI with FLAIR, diffusion and gadolinium contrast recommended.

4. Possible left anteromedial temporal lobe encephalomalacia with ex vacuo dilatation of the left temporal horn lateral ventricle.

(Leptomeningeal pilocytic astrocytoma)