 There is a mixed intermediate and low signal T2 and intermediate and high signal T1 intraparenchymal hematoma centered in the right insula and basal ganglia region that measures up to approximately 6 cm. There is extension of hemorrhage into the right lateral ventricle. The surrounding vasogenic edema with unchanged mild midline shift to the left and uncal herniation. Likewise, there is persistent effacement of the third and right lateral ventricles, but dilatation of the left lateral ventricle. There is a background of diffuse cerebral white matter T2 hyperintensity and punctate foci of encephalomalacia in the pons. There is also linear T2 hyperintensity along the right corticospinal tract in the midbrain, suggestive of early Wallerian degeneration. There are punctate foci of susceptibility effect within the medial portions of the cerebellar hemispheres. The susceptibility -weighted images are otherwise degraded by patient motion. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.
1. Accounting for differences in technique, there is no significant interval change in size of the acute to early subacute intraparenchymal hemorrhage centered in the right insula and basal ganglia region, which is likely hypertensive in nature, with associated intraventricular extension of hemorrhage, and vasogenic edema, leftward midline shift, and obstructive hydrocephalus involving the left lateral ventricle. 2. Diffuse cerebral white matter small vessel ischemic disease and punctate foci of encephalomalacia in the pons, but no evidence of acute territorial infarct.3. Punctate foci of susceptibility effect within the medial portions of the cerebellar hemispheres may represent chronic hypertensive microhemorrhages.