Left-sided neglect and intracranial hemorrhage on recent CT. Evaluate for abnormalities. MRI Brain:Redemonstrated is a right occipital lobe intraparenchymal hematoma with extension into the right temporal and inferior parietal lobule. The size of the hemorrhage measures approximately 34 x 35 mm which appears similar in size compared to the recent previous head CT. The susceptibility weighted sequences demonstrate motion artifact but there is extensive susceptibility artifact in the right occipital region in the area of known hemorrhage as well as a punctate focus in the left parietal lobe. There is surrounding T2/FLAIR signal abnormality surrounding the right-sided hematoma indicating vasogenic edema which causes minimal mass effect on the trigone of the right lateral ventricle. The small amount of subarachnoid and subdural hemorrhage is also unchanged. There is minimal 2 mm midline shift to the left but this too is unchanged. No uncal herniation. The ventricles and basilar cisterns are unchanged. Redemonstrated are mild patchy areas of subcortical and periventricular T2/flair hyperintensity within the white matter. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. Minimal mucosal thickening is visualized in the sphenoid sinus. MRA Brain:The intracranial internal carotid arteries demonstrate no significant stenosis. There is minimal ectasia of the left cavernous segment of the ICA without a definite aneurysm. The middle and anterior cerebral arteries are also patent. The vertebral arteries, basilar artery, and posterior cerebral arteries also are patent with no significant stenosis. Minimal asymmetric prominence is noted of the vasculature in the right parieto-occipital region which is nonspecific and may be related to congestion. There is no nidus appreciated in the region of hemorrhage in the right occipital lobe that may represent a vascular malformation. The prior MRI in 2010 demonstrates no abnormal flow voids in this region either.
1.No significant change in intraparenchymal hematoma centered in the right occipital lobe with surrounding edema and adjacent small volume subarachnoid and subdural hemorrhage. 2.There is mild asymmetric prominence of the vasculature in the right parieto-occipital region which is nonspecific but may be related to congestion. There is no nidus appreciated that may represent an AVM and the previous MRI from 2010 shows no abnormal flow voids in this region. No underlying mass within the limits of noncontrast study.3.Given a second focus of microhemorrhage within the left parietal lobe (which is chronic) also in a peripheral lobar distribution and patient age, findings suggest amyloid angiopathy as the etiology. Follow-up imaging with contrast can be considered as clinically appropriate.4.No flow limiting steno-occlusive disease or aneurysm within the intracranial vasculature.