Female, 65 years old, nontraumatic intracranial hemorrhage and history of breast carcinoma. HCT done 10/27 showed an interval slight increase in ICH. MRI done the same day demonstrated 4.5x3x4.6 cm ICH with 5 mm left to right shift with no clear underlying mass. The previously demonstrated large intraparenchymal hemorrhage in the left occipital lobe has decreased in size since the prior examination and now measures up to 3.9 x 3.4 x 4.1 cm (TV by AP by CC). There has been interval evolution of the signal of the blood products with peripheral hemosiderin staining and central high T2 and T1 signal indicating late subacute blood. Mild peripheral enhancement is present, which can be seen with hematoma. No definite masslike enhancement is identified. Mild residual surrounding edema is seen, improved from prior. The atrium of the left lateral ventricle has reexpanded, and there has been interval resolution of previously demonstrated midline shift. Several punctate foci of susceptibility are seen in the tissues surrounding the hematoma but separate from the main collection. Elsewhere in the brain, however, no definite additional hemosiderin staining is demonstrated.There is no diffusion abnormality to suggest acute infarct. No new intracranial mass or mass effect. Numerous scattered foci of T2 hyperintensity are seen within the cerebral white matter, nonspecific and unchanged. The ventricles and sulci are within normal limits for age. No new abnormal extra-axial fluid collection is identified. Normal flow-voids are demonstrated in the major intracranial vascular structures. A small developmental venous anomaly is noted incidentally in the right cerebellum. The midline structures and craniocervical junction are within normal limits.MRA HEAD
Interval evolution and improvement in size of the intraparenchymal hemorrhage in the left occipital lobe. Improved associated edema and mass effect. No definite underlying enhancing mass or vascular malformation is identified. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.