Subarachnoid hemorrhage, assess for extensiveness. Diffuse encephalopathy, LUE decorticate posturing. Again seen are numerous foci of microhemorrhage, increased from 3/28/2016 MRI, some of which demonstrate restricted diffusion, including in the left occipital lobe. Multiple new foci of FLAIR signal abnormality are seen in the bilateral occipital lobes, the bilateral inferior frontal lobes, the right anterior frontal lobe and the left anterior temporal lobe at least most of which clearly correspond to adjacent blood products. Some of these FLAIR foci demonstrate restricted diffusion.Increased FLAIR sulcal signal in the superior right parietal lobe, right frontal lobe, left occipital lobe and left temporal lobe representing subarachnoid hemorrhage. Small amount of intraventricular blood product appears similar to 4/18/2016 CT head. Ventricles and basal cisterns are unchanged. There is no mass effect or herniation. There is nonspecific opacification of the mastoid air cells and paranasal sinuses. Partially empty sella.
Scattered areas of subarachnoid and intraventricular hemorrhage appear similar to 4/18/2016 CT head. However the numerous foci of microhemorrhage throughout the brain are significantly increased when compared to prior brain MRI from 3/28/2016. Some of these foci demonstrate restricted diffusion which may be related to the blood products themselves although small infarcts with hemorrhagic transformation are not entirely excluded. FLAIR hyperintensity surrounding these foci are compatible with foci of edema related to the hemorrhages. No findings to suggest acute large vascular territory infarct.The numerous foci of small intra and extra-axial hemorrhage may be related to vasculitis as noted previously although thrombocytopenia may also be contributing.