 BRAIN: There is abnormal T2 hyperintensity noted on the FLAIR sequence within the occipital horns, anterior suprasellar cistern, interpeduncular cistern and sylvian fissures compatible with subarachnoid and intraventricular hemorrhage. There is no MR evidence of tentorial subdural hematoma. The prior CT findings were likely artifactual. Additional T2 hyperintensity on the FLAIR sequence within multiple parietal and occipital sulci is most likely artifactual secondary to sedation and oxygenation.The intraventricular hemorrhage demonstrates susceptibility effect. Additional susceptibility effect is present within the fourth ventricle, secondary to additional blood products versus choroid plexus. There is unchanged mild dilatation of the temporal horns. There are abnormal patchy foci of T2 hyperintensity within the deep frontal and parietal white matter. There is no evidence of acute infarct. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull and scalp soft tissues are unremarkable. There is paranasal sinus mucosal thickening and fluid within the bilateral mastoid air cells.MRA HEAD: Images are somewhat limited by artifact likely due to patient positioning during the exam. The intracranial internal carotid arteries are normal in course and caliber. The middle and anterior cerebral arteries are unremarkable. The vertebral arteries, basilar artery, and posterior cerebral arteries are normal in course and caliber. There is no evidence of flow-limiting stenosis or aneurysm.MRV HEAD: No evidence of thrombosis within the major dural venous sinuses or major cerebral veins.
1.Scattered mild subarachnoid hemorrhage and intraventricular hemorrhage with unchanged mild ventricular dilatation. This may possibly be secondary to cyclosporine toxicity or coagulopathy.2.Patchy white matter signal abnormalities are nonspecific with the differential including infectious/inflammatory etiologies, but could also be seen with intracranial manifestation of the patient's known HLH. No evidence of corresponding enhancement.3.No evidence of intracranial aneurysm, vascular malformation or venous sinus thrombosis.4.Paranasal sinus mucosal thickening and mastoid air cell fluid may be infectious or secondary to intubation. Please correlate clinically.