Nontraumatic intracerebral hemorrhage in the brainstem. Follow-up of pontine hemorrhage. This is a motion degraded exam. There is redemonstration of T1 and T2 hyperintense hemorrhage with surrounding rim of hypointense signal along the left posterior aspect of the pons, which extends to the brachium pontis and measures up to 2.5 cm. There is further interval decrease in compression of the fourth ventricle, consistent with decreased mass effect from the hemorrhage. No new hemorrhage is apparent. The previously demonstrated small foci of dependent intraventricular hemorrhage in the occipital horn is no longer apparent, although artifacts limit assessment. There is mild brain parenchymal volume loss. There are patchy and confluent intracerebral white matter T2 hyperintensity, which are stable and likely represent chronic small vessel ischemic disease. There is an unchanged punctate focus of susceptibility effect in the right thalamus, which may represent a chronic microhemorrhage. There is no midline shift or herniation. There is interval appearance of fluid in the right frontal, right ethmoid and near complete opacification of the right maxillary sinus, with interval progression from prior. There is probable small retention cyst as well as mild mucosal thickening in the left sphenoid sinus. There is bilateral mastoid air cell fluid, which has increased since the previous exam. The orbits, skull, and scalp soft tissues are grossly unremarkable.
1. Expected evolution of the left subacute pontine and middle cerebellar peduncle hemorrhage with further interval decrease in mass effect upon the fourth ventricle. No evidence of acute intracranial hemorrhage.2. Stable moderate chronic small vessel ischemic disease, but no evidence of acute infarction.3. Increased fluid within the right maxillary, ethmoid, and frontal sinuses may relate to sinusitis. 4. Progression of bilateral mastoid mucosal thickening, which may represent mastoiditis. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.