Left basal ganglia hemorrhage. Intraventricular hemorrhage. Likely cocaine vasculopathy. Evaluate for MISTIE trial. The study is mildly limited by motion.The large intraparenchymal hemorrhage involving the left basal ganglia region with superior and inferior extensions into the left frontal and temporal lobes, respectively, has not significantly changed since the CT done earlier on the same day. Given the different angulation for the axial planes between CT and MR, the size of the hemorrhage is better assessed on the coronal and sagittal planes. On the coronal T2 weighted sequence, the hemorrhage measures 5.0 cm x 2.5 cm compared to 5.1 cm x 2.5 cm previously. Anteroposteriorly on the sagittal T1 sequence, the hemorrhage measures 5.9 cm compared to 5.8 cm previously. The hematoma is heterogeneously T1-hyperintense, T2-hypointense but is T1-hypointense at the periphery, reflecting its early subacute nature. It is associated with relatively mild and unchanged surrounding T2-hyperintensity/vasogenic edema. The associated mass-effect is unchanged compared to the previous CT scan, with midline shift of 4 mm as measured at the lower aspect of the septum pellucidum and mild mass-effect on the left lateral and third ventricles. The hematoma still abuts the frontal and temporal horns of the left lateral ventricle. Susceptibility effect related to the intraventricular component of the hemorrhage is similar to the previous CT scan in distribution. Lack of signal suppression on FLAIR sequences involving the occipital and posterior parietal sulci probably reflects mild redistribution of hemorrhage into the subarachnoid space. Following contrast injection, there is suggestion of vague ill-defined enhancement along the posterolateral margin of the hemorrhage (best seen on image #188 of series #1401). Otherwise, there is no significant contrast enhancement in the intraparenchymal hemorrhage or elsewhere in the brain.There is an additional, small focus of parenchymal blood product manifested by susceptibility effect in the medial aspect of the left frontal lobe, image #152 of series #901, which correlates with a tiny focus of hyperattenuation on the CT scan.There is no brain parenchymal diffusion restriction to suggest acute infarct.Accounting for mass-effect on the left lateral and third ventricles, there is no significant ventricular dilatation. The sulci are mildly enlarged in a global fashion reflecting underlying brain volume loss. The basal cisterns remain open though the ambient cisterns are mildly asymmetric.
1.The large intraparenchymal hematoma in the left basal ganglia region has not significantly changed since the CT scan done earlier on the same day. Associated surrounding edema and mass-effect remain mild. The hemorrhage is associated with a small focus of questionable mild parenchymal contrast enhancement along the posterolateral margin, which is nonspecific and could very likely be reactive to the hemorrhage. No definite evidence of an underlying lesion is seen.2.The intraventricular component of the hemorrhage is also not significantly changed and is not associated with progressive ventricular enlargement. The hemorrhage has redistributed into the subarachnoid space posteriorly.