 BRAIN: There are multiple punctate foci of restricted diffusion within the right periventricular white matter, right basal ganglia, left hemi-midbrain, and right cerebellar white matter. There is a T1 and T2 hyperintense area of signal abnormality within the left thalamus that measures 26 x 12 mm corresponding to the known recent hemorrhage, with surrounding susceptibility effect and FLAIR hyperintense vasogenic edema. There is stable mild mass effect upon the third ventricle and 6 mm rightward midline shift. There is also a prominent area of susceptibility effect within the medial right thalamus that may represent prior hemorrhage. There are multiple patchy foci of T2 hypertensity throughout the supratentorial and infratentorial white matter. There is a probable right frontal lobe developmental venous anomaly. There is no hydrocephalus. There is a partially empty sella. The major cerebral flow voids are intact. There is a chronic deformity of the left medial orbital wall.MRA HEAD: 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.
1.Subacute left thalamic hematoma with unchanged mass effect and mild midline shift. Chronic right medial thalamic hemosiderin deposition, likely relating to hypertensive disease as well.2.Multiple supratentorial and infratentorial punctate foci of acute ischemia in multiple vascular distributions raising suspicion for emboli or vasculopathy.3.Chronic small vessel ischemic disease.4.Unremarkable MRA head.These findings were discussed with Dr. Hobbs on 6/6/2015 at 2:45 PM.