Nontraumatic intracerebral hemorrhage, intraventricular [I61.5], Reason for Study: ^Reason: eval for new infarct History: worsening LUE weakness Brain MRIMultifocal scattered restricted diffusion lesions involving bilateral frontal lobe and corpus callosum splenium (right ACA and MCA territory as well as left ACA territory) as well as right cerebellar hemisphere indicating acute ischemic infarct (vertebrobasilar artery territory).Acute intracranial hemorrhage involving right basal ganglia and intraventricular hemorrhage are seen with encephalomalacia on the right frontal lobe indicating chronic ischemic infarction (right MCA territory).Ventriculostomy tube is inserted through the right lateral ventricle frontal horn and the tip is located at or around right side foramen of Monro, comparing to prior CT scan, there is no significant interval change of ventricle size. The paranasal sinuses and mastoid air cells are clear.Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate non visualization of the right MCA from the distal right ICA as well as fine arterial signal intensities on the distal left ICA at or around the origin of the left ACA A1 segment. The vertebrobasilar artery system appears to be normal.Constellation of above findings indicate possible Moyamoya phenomenon
1. Acute ICH at the right basal ganglia with acute IVH on bilateral lateral ventricles.2. Acute ischemic infarctions involving bilateral frontal lobes (bilateral ACA and right MCA territory), corpus callosum splenium and right cerebellar hemisphere (vertebrobasilar system territory).3. Chronic ischemic infarction at the right frontal lobe (right MCA territory).4. Ventriculostomy tube inserted through the right frontal burr hole, unchanged since prior CT scan.5. Non visualization of the right ACA A1 segment and MCA with multiple small arterial signal intensities on the left ICA bifurcation indicate Moyamoya phenomenon (disease). 