Clinical question: Evaluate prior ICH. Patient with recent diagnosis of multiple myeloma. Signs and symptoms: ICH. Pre and post enhanced brain MRI:Examination demonstrates a large focus of right anterior frontal hemorrhagic encephalomalacia at the site of previously noted large parenchymal hematoma.There is a thin irregular rim of enhancement surrounding the hemorrhagic cavity which is an expected finding and representing evolving hematoma.There is significant interval decrease in the overall size of this finding and with significant interval resolution of surrounding residual leak edema. Changes results in mild ex vacuo dilatation of right frontal horn and without evidence of mass effect and resolution of previously noted midline shift to the left. Expected postoperative changes of a right frontal craniotomy with subtotal underlying epidural thickening and enhancement.Few tiny foci of FLAIR hyperintensity only in the subcortical white matter of bilateral hemispheres remain similar to prior exam.Normal signal intensity and anatomical morphology of the brain parenchyma otherwise unremarkable MRI sequences. No detectable abnormal parenchymal or leptomeningeal enhancement other than above findings.Unremarkable images through the orbits and including axial fat sat post enhanced series.The signal intensity of the calvarium is bleeding normal and without abnormal enhancement.
1.Significant interval improvement of a resolving hematoma and postoperative changes in the right frontal lobe as detailed above.2.Resultant mild expansion of right lateral ventricle and resolution of midline shift.3.Negative diffusion weighted series.4.Few punctate nonspecific foci of FLAIR hyperintensity only in the subcortical white matter without change since prior exam.