Diagnosis: Slurred speechClinical question: strokeSigns and Symptoms: stroke MRI of the brainThere is a hematoma centered in the right frontal lobe involving the right middle and inferior frontal gyri which is associated with a vasogenic pattern of edema. There is shift of the septum pellucidum approximately 7 mm to the left of midline.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. There are punctate foci of T2 and FLAIR signal hyperintensity present in the brainstem.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRV brain:The dural venous sinuses are patent. Straight sinus, internal cerebral veins and basal veins are identified and appear patent.
1.There is a large hematoma centered in the right frontal lobe associated vasogenic edema and midline shift.2.Periventricular and subcortical white matter punctate lesions of a mild degree and punctate lesions in the brainstem are nonspecific. At this age they are most likely vascular related. 3.There is no evidence for dural venous sinus thrombosis to explain the patient's hemorrhage.4.Etiology for the patient's right frontal lobe hemorrhage cannot be established on this exam. It's possible that an underlying mass or other cause may be masked by the sheer size of the hematoma.