Left-sided craniotomy noted. There are three peripherally enhancing lesions in the left frontal lobe, measuring 2.8 x 3.1 cm anterosuperiorly in the middle frontal gyrus, 2.7 x 2.7 cm posteriorly and 16 x 10 mm anteroinferiorly. These demonstrate central diffusion restriction. The lesions demonstrate peripheral T1 hyperintensity and T2 hypointensity associated with susceptibility artefact consistent with subacute haemorrhage. Left frontal leptomeningeal and pachymeningeal enhancement is demonstrated. Bifrontal subdural collections measuring 6 mm on the right and 8 mm on the left and right parafalcine subdural collection measuring 4 mm do not demonstrate complete FLAIR suppression, however there is no enhancement or diffusion restriction to suggest empyaema.
There is extensive surrounding FLAIR hyperintensity in the left frontal lobe extending into the parietal lobe and mass effect characterised by sulcal effacement, partial effacement of the left lateral ventricle and rightward midline shift of 4 mm. The ventricles are stable in size. Cavum septum pellucidum et vergae incidentally noted.
Evidence of sinusitis involving the maxillary and sphenoid sinuses and is more air cells.
Conclusion:
Appearances are worrisome for abscess formation in the regions of prior haemorrhagic contusions in the left frontal lobe, associated with considerable oedema and mass effect. Left frontal leptomeningeal enhancement suggests meningitis.