Intracerebral hemorrhage. Evaluate for stroke. There are post-procedural changes related to embolization of the quadrigeminal plate cistern arteriovenous malformation and associated aneurysms. Redemonstrated is hematoma in the right dorsal midbrain with extension into the third and bilateral lateral ventricles. There are small foci of restricted diffusion in the bilateral cerebellar hemispheres, right parieto-occipital region, left occipital lobe, right posterior frontal lobe, left medial temporal lobe, as well as inferior to the right dorsal midbrain hematoma, consistent with acute ischemic lesions.A right frontal approach ventriculostomy catheter is unchanged in position and courses into the right lateral ventricle with tip in the region of foramen of Monro. The lateral and third ventricles are prominent and unchanged in size. There is a chronic lacunar infarct in the right basal ganglia. There is no mass effect or midline shift. There are scattered punctate foci and confluent areas of abnormal T2 hyperintensity within the periventricular and subcortical white matter, consistent with moderate chronic small vessel ischemic changes. There is no midline shift or herniation. The skull and extracranial soft tissues are unremarkable. There is diffuse mild mucosal thickening of the paranasal sinuses and small mucus retention cysts in the bilateral maxillary sinuses.
1. Multiple small foci of restricted diffusion in the supra- and infratentorial compartments, consistent with acute ischemic lesions. 2. Again seen is hematoma in the right dorsal midbrain with extension into the third and bilateral lateral ventricles. 3. Unchanged position of ventriculostomy tube without significant interval change in ventriculomegaly.4. Moderate periventricular and subcortical white matter changes, which are nonspecific, but most likely represent chronic vessel ischemic disease. Findings discussed with Dr. Mansour on 3/18/2015 at the time of dictation. 