Clinical question: Rule out extension of the hemorrhage, tumor. Signs and symptoms: ICH. Pre-and post-enhanced brain MRI:Negative diffusion weighted images.Examination demonstrate a focus of susceptibility signal change and hypointensity on T2-weighted images consistent with hemosiderin deposition at the site of previously known left anterior frontal hematoma. There is interval decreased size hemorrhage and complete resolution of surrounding vasogenic edema. There is no associated mass effect or gliosis. This focus measures approximately 9.5 x 27-mm in size. On post enhanced images there is significant interval decrease in the enhancement of the lesions since prior study and only tiny residual foci of enhancement in the rim of the lesion is identified. There is no evidence of mass as is questioned clinically. Appearance of the finding also is not suggestive of a cavernoma however this possibility cannot be entirely excluded.There are a few tiny foci of flair hyperintensity in the periventricular and subcortical white matter which although nonspecific considering patient's stated age of 69 the possibility of minute chronic nonhemorrhagic small vessel ischemic strokes should be considered.The anatomical morphology as well as signal intensity of brain parenchyma otherwise remains within normal patient's stated age of 69.Calvarium and soft tissues of the scalp are unremarkable. Unremarkable images through the orbits, paranasal sinuses and mastoid air cells. A single left posterior ethmoid air cell opacification however is detected.
1.Negative diffusion weighted images.2.Interval decreased size of left frontal hematoma and complete resolution of surrounding edema and with trace residual enhancement as detailed. There is no evidence of an underlying vascular malformation or mass present as is question clinically.3.Finding suggestive of minimal chronic nonhemorrhagic small vessel ischemic strokes