33 years Male (DOB:2/14/1983)Reason: Evaluate ICH History: ICH with multiple bilateral strokesPROVIDER/ATTENDING NAME: CHRISTOPHER L KRAMER CHRISTOPHER L KRAMER MRI of the brainThere is susceptibility effect compatible with hemorrhage involving the posterior cerebral artery territories in a gyriform pattern. This involves bilateral lingual gyri including calcarine cortex and extends to the fusiform gyri bilaterally but more so on the left than the right side and the left hippocampus. There is surrounding vasogenic edema and there is mass effect. There is T2 and FLAIR signal hyperintensity involving the posteromedial aspect of the right cerebellar hemisphere approximately 40x25 mm axial dimensions. This is associated with some punctate foci of susceptibility effect. There is a punctate focus of T2/FLAIR signal hyperintensity in the right thalamus. There is an 8mm focus of T2/FLAIR signal hyperintensity centered in the left lateral geniculate nucleus. There is a 4mm focus of T2/FLAIR signal hyperintensity centered in the right posterolateral medulla. A couple punctate foci of T2/FLAIR signal hyperintensity are present in the left cerebellar hemisphere.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA brain:There are bilateral vertebral artery dissections which appear worse on the right versus the left side. On the right side there is visible mural thrombus dues to dissection which extends from the C2 vertebra to the dura. The RVA dissection is associated with greater than 50% stenosis. On the left a dissection - associated with less mural thrombus than the right - extends from the vertebral artery foramen of C2 to approximately once cm proximal to the dura. The LVA dissection is associated with less than 50% stenosis. Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified and is medium size. The right A1 segment is hypoplastic. The posterior communicating arteries are very small. MRA neck:There are bilateral vertebral artery dissections which appear worse on the right versus the left side. On the right side there is visible mural thrombus dues to dissection which extends from the C2 vertebra to the dura. The RVA dissection is associated with greater than 50% stenosis. On the left a dissection - associated with less mural thrombus than the right - extends from the vertebral artery foramen of C2 to approximately once cm proximal to the dura. The LVA dissection is associated with less than 50% stenosis. There is opacification of the great vessels from the aortic arch, carotid arteries and vertebral arteries. The origins of the great vessels from the aortic arch are not included. On the basis of NASCET criteria there is no significant stenosis at the carotid bifurcations.
1.Late subacute stage infarctions involving the PCA territories bilaterally (left more than right), right posteromedial cerebellum, right thalamus, left lateral geniculate body and right posterolateral medulla with hemorrhagic conversion of the PCA territory infarcts.2.Bilateral vertebral artery dissections (most likely intimal dissections) associated with stenosis (right worse than left) and mural thrombus. Although the one on the right extends to the dura it does not appear to extend intracranially at this time.