Comatose, intracranial hemorrhage, evaluate for structural lesions. MRI brain: Again seen is intra-parenchymal hematoma centered within the pons measuring approximately 32 x 37 x 47 mm. There is surrounding edema and partial effacement of the fourth ventricle. Again seen is tiny amount of hemorrhage within the ventricular system, layering within the occipital horns. Small foci of susceptibility within the bilateral basal ganglia are compatible with mineralization versus chronic hemorrhage. Minimal extra-axial blood products are noted along the right parietal convexity. Tiny focus of susceptibility seen within the left cerebellar hemisphere, image 33/212, left thalamus, image 118/212, and medial temporal lobes.There is no significant change in mild ventriculomegaly compared to CT. Right transfrontal EVD catheter is in place with small amount of edema as well as small subarachnoid hemorrhage along the catheter tract. There is periventricular FLAIR hyperintensity compatible with transependymal flow. Small perivascular spaces in the basal ganglia. Minimal scattered foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with mild age related white matter changes. Brain parenchyma is otherwise unremarkable for age. No abnormal parenchymal or meningeal enhancement. Major flow-voids are preserved.Sella and orbits are grossly within normal limits. There is diffuse opacification of the bilateral mastoid air cells. Mucosal thickening involving the maxillary sinuses and patchy opacification of the ethmoid and sphenoid sinuses again seen. Bone marrow signal and extracranial soft tissues are within normal limits. MRA head: Examination is slightly motion degraded. The intracranial internal carotid arteries demonstrate no significant stenosis. The middle and anterior cerebral arteries are also patent. Incidentally seen is a hypoplastic left A1. The vertebral arteries, basilar artery, and posterior cerebral arteries also are patent with no significant stenosis. Intracranial right vertebral artery is hypoplastic. No evidence of aneurysms or vascular malformations.
1. Large hematoma centered within the pons is again seen. No associated masses or abnormal enhancement is appreciated. Follow-up evaluation once hematoma resolves may be helpful to exclude possibility of underlying lesion if clinically indicated.2. Few tiny foci of susceptibility as detailed above including the left cerebellar hemisphere and left thalamus which are nonspecific but may represent chronic microhemorrhages; correlate for history of chronic hypertension. Additional foci in the bilateral basal ganglia may represent additional foci of chronic hemorrhages versus mineralization which is not evident on CT.2. MRA demonstrates no aneurysms or vascular malformations. No significant stenosis is appreciated.3. Unchanged mild ventriculomegaly with right transfrontal EVD in place.