76 years old, Male, Reason: eval for structural lesions History: AMS MRI:Redemonstration of a left thalamic hematoma, stable in size and morphology, with intraventricular extension. There is a moderate amount of surrounding edema in the thalamus, which does not appear significantly changed from the most recent CT. There is continued rightward midline shift secondary to mass effect of the hemorrhage and surrounding edema measuring up to 6 mm. There is dissection of this hematoma into the ventricular systems with subacute blood products layering in the occipital horns of the lateral ventricles. Patchy periventricular T2 hyperintensities indicates age indeterminate small vessel ischemic disease. Ventricular volumes appear mildly prominent, unchanged.Sella and orbits are grossly within normal limits. Paranasal sinuses and mastoid cells are clear. Bone marrow signal and extracranial soft tissues are within normal limits. MRA: Motion limits fine detail. There is antegrade flow within the distal bilateral vertebral arteries, within the basilar artery, distal bilateral internal carotid arteries and carotid siphons and bilateral anterior, middle and posterior cerebral arteries. In the area of the hemorrhage, hyperintense T1 signal is secondary to subacute blood products and there is no definite evidence of AVM. No arterial occlusions, arteriovenous malformations, or aneurysms are identified elsewhere within the brain. There is mild atherosclerotic narrowing of the right cavernous ICA, which may be artifactual.
1. Expected evolution of left thalamic hematoma, surrounding edema and mass effect with mildly decreased rightward midline shift.2. No underlying structural lesion such as AVM or mass causing the left thalamic hematoma.