Clinical question: Rule out vessels and hemorrhage. Signs and symptoms: As above. Nonenhanced brain MRI:The examination demonstrates a previously known large new right thalamic acute hematoma measuring at 27 x 35mm in transaxial dimension. There is surrounding vasogenic edema and resultant mass effect on the third ventricle however without evidence of midline shift. There is dissection of hemorrhage into the ventricular system as was noted on prior study and without significant change. There is mild dilatation of the supratentorial ventricular system (right greater than left without significant change since prior study. A left frontal approach ventricular catheter with the tip in the body of right lateral ventricle similar to prior exam is again noted.Additionally examination demonstrate multiple small foci of flair hyperintensity in bilateral subcortical and periventricular white matter as well as right basal ganglia consistent with chronic small vessel ischemic strokes.Small foci of hemorrhagic encephalomalacia in the left anterior frontal and a smaller in the right anterior frontal lobes as noted on prior exam.Nonenhanced brain MRA:Examination demonstrate no evidence of vascularity within the right thalamic hemorrhage or in the surrounding brain parenchyma to suggest a vascular malformation.Bilateral internal carotid arteries remain widely patent across the skull base and in their supraclinoid segments.Bilateral anterior and middle cerebral arteries are patent. There is a tiny vascular outpouching along the superior aspect of the right M1 segment of middle cerebral artery is present and is suggestive of a tiny infundibulum. Less likely possibility of a small aneurysm cannot be entirely excluded however. Distal branches of bilateral anterior and middle cerebral arteries are unremarkable. There is no detectable abdomen AP at the level anterior communicating artery. Bilateral two arteries, bilateral pica branches, basilar artery and all of its branches are visualized and unremarkable.
1.Nonenhanced brain MRI demonstrate no evidence of any acute or new finding since prior exam. Acute hematoma in the right thalamus, surrounding vasogenic edema, dissection of hemorrhage into the ventricular system remain all very similar to prior study. Shunted lateral ventricles demonstrate no change in size or position of the left ventricular catheter. Chronic small vessel ischemic strokes and bilateral anterior frontal (left greater than right) encephalomalacia as was noted on prior studies.2.Nonenhanced brain MRA demonstrate no detectable increased vascularity within the right thalamic hemorrhage or its surrounding parenchymal. All major intracranial arteries and their distal branches remain patent. Tiny focus of vascular outpouching along the superior aspect of right MCA is believed to represent an infundibulum. Less likely possibility of a tiny aneurysm cannot be entirely excluded. Unremarkable nonenhanced MRI otherwise.