Clinical question: Brain parenchymal injury/intraventricular hemorrhage. Signs and symptoms: Head trauma. Nonenhanced brain MRI:Diffusion weighted images demonstrate multiple varying size small foci of restricted diffusion involving the cortex and subcortical white matter of bilateral cerebral hemispheres.Regions of acute stroke demonstrate no evidence of hemorrhagic changes when compared with susceptibility MRI sequences. The largest finding in the right hemisphere is in the right posterior temporal cortex and measuring at approximately 6 x 12 mm in transaxial dimensions. The largest left hemispheric lesion is in the left frontal and partially involves the left insular cortex and measuring at approximately 8 x 9 mm in transaxial dimensions. These lesions are well identified as foci of T1 hyperintense and T2 hyperintense and without significant mass effect.Examination additionally demonstrate focus of acute hemorrhage hemorrhage/hematoma in the midline projecting in an AP semierect tibia at least partially within the corpus callosum and partially within the cisterna velum interpositum and with a small amount of hemorrhage in the right lateral ventricle as was noted on prior head CT.There is extra-axial subdural collection also in the right frontal and temporal convexity with subtle mass effect on the adjacent parenchyma and measuring maximum of 4 mm in thickness. Previously noted on head CT small right sided subdural hematoma along the right tentorial leaf is again noted and measures approximately 2 mm in maximum thickness.Unremarkable images through posterior fossa.Ventricular system remains within normal size and great maintained midline.The signal void of major intracranial arterial branches are identified.Images through the orbits are grossly unremarkable on this nondedicated study.There is extensive (R>L) opacification of mastoid air cells.Paranasal sinuses demonstrate mild sphenoid mucosal thickening.Nonenhanced brain MRA:Patent and unremarkable bilateral vertebral arteries, left PICA, dominant right Aica, basilar artery, superior cerebellar and posterior cerebral arteries and their branches.Patent and unremarkable right internal carotid artery, right anterior and middle cerebral arteries and their branches.Patent and unremarkable left internal carotid, left anterior and middle cerebral arteries.
1.Multiple scattered foci of restricted diffusion/acute stroke in bilateral cerebral hemispheres without evidence of hemorrhagic changes as detailed/measured above.2.Midline hemorrhage likely partially within the corpus callosum and partially within the cisternal development of positive as well as right lateral ventricle without significant change since prior head CT exam.3.Right frontal and temporal subdural measuring maximum of 4 mm in size is more conspicuous on this exam compared to prior CT.4.Subdural noted on prior head CT along the right tentorial is again identified and stable since prior exam with maximum of 2 mm in thickness.5.Opacification of bilateral mastoid air cells (R>L).6.Grossly unremarkable images through the orbits and paranasal sinuses.7.Unremarkable brain MRA.