Nontraumatic intracranial hemorrhage, unspecified [I62.9], Reason for Study: ^Reason: right midbrain hemorrhage History: weakness, ptosis Brain MRIThere is focal susceptibility lesion on the right thalamus which extends toward right side cerebral peduncle with surrounding edema indicating focal parenchymal hemorrhage.There are, however, multifocal scattered bihemispheric susceptibility lesions without associated surrounding edema indicating possible chronic hemorrhagic foci.There is tissue loss at the left side of lower pons and part of middle cerebellar peduncle.The ventricles, sulci and cisterns are symmetric and unremarkable. The paranasal sinuses and mastoid air cells are clear.Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate elongated and ectatic basilar artery with luminal irregularities of distal bilateral vertebral arteries indicate "dolichoectatic changes of vertebrobasilar system" suggesting intracranial atherosclerosis.Some irregularities are seen on bilateral MCA M1 segments but no evidence of major vessel occlusion.There is no intracranial arterial aneurysm seen.There is no MRA evidence of arteriovenous shunt, however, MRA cannot rule out possibility of arteriovenous shunting. Therefore, if clinically indicated, diagnostic catheter angiography for further imaging evaluation can be considered.
1. Acute ICH on the right mesial inferior thalamus which extends toward right side cerebral peduncle as described above.2. Multifocal chronic petechial hemorrhages as well as focal tissue defect on the left side lower pons.3. No evidence of acute ischemic lesion.4. Atherosclerotic changes of intracranial arterial system without evidence of arterial luminal stenosis, nor intracranial arterial aneurysm. 