Evaluate for ischemic lesion or change since initial intracranial hemorrhage. There is a new punctate focus of diffusion restriction in the left cerebellar hemisphere.There are postoperative findings with track related to placement and removal of a prior right frontal approach catheter. There is interval decrease in the size of the right thalamic and posterior basal ganglia hematoma, which measures 3.1 x 3.0 x 2.9 cm (AP x TR x CC), previously 3.5 x 4.2 x 4.3 cm on 6/7/2015. There is surrounding edema with stable mass effect on the frontal and posterior horn of the right lateral ventricle. There is right to left midline shift measuring 7 mm, previously 8 mm. There is a trace subdural collection along the right frontal lobe with trace layering blood products measuring 4 mm in width, unchanged from CT head of 6/10/2015. A small amount of subarachnoid hemorrhage in the left posterior temporal-parietal region is again noted. There are trace bilateral layering intraventricular hemorrhages. The ventricular size and morphology is unchanged. There is susceptibility effect compatible with chronic microhemorrhage involving the left basal ganglia and thalamus. There are scattered patchy foci of T2 hyperintensity throughout the supratentorial and infratentorial white matter that are most compatible with chronic small vessel ischemic disease. Mild asymmetric T2 hyperintensity within left dentate nucleus is nonspecific but may also represent chronic small vessel ischemic disease. There is mild ectasia of the distal right internal carotid artery. The major cerebral flow voids are intact. There is trace scattered mucosal thickening of the paranasal sinuses. There is fluid within the nasopharynx. There is increased partial opacification of the bilateral mastoid air cells.
1. New punctate focus of diffusion restriction in the left cerebellar hemisphere, consistent with a microinfarct.2. Interval decrease in size of the right thalamic and posterior basal ganglia hematoma with similar appearance of the surrounding edema, mass effect and midline shift towards the left. 3. Stable small amount of subarachnoid hemorrhage in the left posterior temporal-parietal region.4. Stable trace bilateral layering intraventricular hemorrhages.5. Stable trace subdural collection along the right frontal lobe.6. Evidence of remote hemorrhages involving the left thalamus and basal ganglia again seen. Distribution favors a hypertensive etiology. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.