Clinical question: Evaluate for hemorrhage and edema. Signs and symptoms: Evaluate for edema. Nonenhanced brain MRI:Examination demonstrates an acute hematoma in the left thalamus measuring 18 x 20 mm in transaxial dimensions and without significant change since prior head CT exam.Diffuse surrounding vasogenic edema and resultant mass effect on the adjacent ventricle and trace to radiation of midline to the right demonstrate no significant change.Similar to prior exam there is evidence of extension of hemorrhage extensively into the right lateral ventricle without change.Stable mildly dilated lateral ventricles and prominence of bilateral cerebral cortical sulci without change since prior study.Extensive subcortical, periventricular, basal ganglia, thalamic and pontine foci of FLAIR hyperintensity highly suspected of advanced chronic small vessel ischemic strokes is noted. There is minimal susceptibility signal changes in the pons representing chronic hemorrhagic changes.
1.Stable acute left thalamic hematoma, surrounding vasogenic edema, associated mass effect and extension of hemorrhage into the ventricular system since prior study.2.Extensive patchy confluent foci of FLAIR hyperintensity in the periventricular, subcortical, bilateral basal ganglia, left thalamus and extensively of the pons are suggestive of advanced chronic small vessel ischemic strokes. Minimal susceptibility signal changes in the pons suggest chronic hemorrhagic changes.