51 years, Male, subarachnoid hemorrhage, recent catheter angiogram negative with prior CTA questioning tiny aneurysm or venous structure. Brain: Examination is motion degraded. Again seen is extensive subarachnoid hemorrhage involving the subarachnoid cisterns, cortical sulci, as well as intraventricular hemorrhage as demonstrated on recent CT. There is a right transfrontal ventriculostomy catheter with tip near the right foramen of Monro. Ventricular system appears decompressed without evidence of hydrocephalus.Evaluation of the brain parenchyma demonstrates restricted diffusion in the midbrain at the level of the periaqueductal gray matter with associated T2/FLAIR hyperintensity in the paramedian midbrain as within the ventral aspect of the pons. No findings to suggest parenchymal hemorrhage are appreciated. No intracranial mass or mass effect. No parenchymal or meningeal enhancement.Cervical Spine: Examination is motion degraded. Vertebral body heights in the cervical spine are normal. Alignment is grossly maintained. No findings to suggest hemorrhage within the cervical spinal canal is appreciated. No intramedullary or extramedullary mass is appreciated in the cervical spinal canal. No obvious cord signal abnormality is appreciated within the limitations of motion degradation. Moderate degenerative changes are seen with multilevel disc osteophyte complexes and moderate degree of cervical spinal canal stenosis at C3-C4, C4-C5, and C5-C6.
1. Examination is significantly motion degraded however demonstrates no clear source of subarachnoid hemorrhage in the brain or cervical spine.2. Restricted diffusion involving the periaqueductal gray matter, with T2/FLAIR hyperintensity in the bilateral midbrain as well as within the ventral aspect of the pons. Findings suggest edema and ischemic injury. Osmotic demyelination also remains a possibility although distribution is not characteristic.3. Extensive subarachnoid hemorrhage involving the subarachnoid cisterns, cortical sulci, and to a lesser degree ventricles as seen on recent CT. Right transfrontal ventriculostomy catheter in place without evidence of hydrocephalus.4. Moderate degree of cervical spinal canal stenosis from C3-4 to C5-6. No obvious intramedullary or extramedullary lesion is seen in the cervical spine within the limits of motion degradation.