Nontraumatic intracranial hemorrhage, unspecified [I62.9], Reason for Study: ^Reason: evaluate vasculopathy and hemorrhage History: headache, neck pain Brain MRIThere are 2 high signal intensities on diffusion-weighted images. One is curvilinear shaped lesion located on the right proximal pre central sulcus which has suspicious restricted diffusion on ADC map, another is at the right right internal capsule genu with slight extension toward posterior limb which does not show ADC abnormality thus likely represent artifacts. On FLAIR/T2 weighted images, there are multifocal high signal intensity lesions especially involving bilateral fronto parietal convexity sulci. In particular, the lesion seen on DWI appears to be matching with one of high signal intensity lesions within the right precentral sulcus. The right internal capsule lesion is associated with an artifacts on FLAIR/T2 images. Gradient echo images do not show any definitive susceptibility artifacts on these lesions. Corresponding T1 weighted images do not show any significant abnormal finding.Constellation of above findings indicate possible artifacts related to higher molecular materials than CSF such as cellular content or proteinaceous materials within the sulci. However, the possibility of cortical acute ischemic infarction can not be excluded. Further imaging evaluation may be obtained with Brain MRI with and without contrast enhancement if clinically indicated.Previously seen corpus callosum ICH has gotten smaller and the extent of IVH also appears to get decreased which represent normal evolution and resorption process.Ventricle size remains within normal limits. No evidence of ventriculomegaly.The cranial-cervical junction is normal. 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 severe stenosis involving bilateral distal ICAs as well as proximal and distal basilar artery. Comparing to prior CT angiography, bilateral distal ICA stenosis appear to be improved but the basilar artery has been worse.Neck MRA3D MRA neck post-gadolinium images with maximum intensity projections of the cervical vasculature demonstrate normal flow enhancement in a normal aortic arch origin of the right brachiocephalic, left common carotid, and left subclavian arteries. The vertebral artery origins are normal. There is normal flow enhancement through the bilateral common carotid, carotid bifurcations, internal/external carotid, and vertebral arteries.
1. A couple of DWI high signal intensity lesions are seen. The internal capsule lesion is likely an artifact, but the right precentral sulcus lesion could represent local blood brain barrier disruption related changes or subcortical ischemic infarction. Brain MRI pre and post enhanced scan can be considered to clarify the nature of the lesion.2. Previously known corpus callosum hemorrhage and IVH has been decreased in size and extent which represent normal evolution. No ventriculomegaly is seen.3. No other acute ischemic or hemorrhagic lesion is seen.4. Slightly improved the stenosis degree of bilateral distal ICA but worsened basilar artery luminal stenosis since prior CT angiography.5. Normal neck MRA.