Diagnosis: Nontraumatic intracerebral hemorrhage, unspecified. Bladder cancerClinical question: sinus thrombosis underlying cause of hemorrhage MRI of the brainA focus of diffusion weighted imaging signal hyperintensity is present in the left posterior temporal lobe subcortical white matter several foci of diffusion-weighted imaging signal hyperintensity are present in the right temporal lobe subcortical white matter.There is a 62 x 30 mm hematoma centered in left gyrus rectus and extending superiorly from the to the cingulate gyrus. It is associated with surrounding T2 and FLAIR signal hyperintensity compatible with vasogenic edema.On susceptibility imaging there is signal loss along the sulci in the medial aspect of supratentorial hemispheres. Additionally there are punctate foci of signal loss along subcortical white matter in the occipital lobes as well as the posterior temporal lobes and basal frontal lobes subcortical white matter with punctate foci of signal loss also in the cerebellar hemispheres.The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate a mucous retention cyst. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.Some images are degraded due to patient motion artifact.MRV brain:The dural venous sinuses are patent. Straight sinus, internal cerebral veins and basal veins are identified and appear patent. The left jugular vein, sigmoid sinus and transverse sinus are smaller than the right-sided counterparts. There appears to be a fenestration along the superior sagittal sinus posteriorly.
1.There is a hematoma centered in the left anterior frontal lobe associated with some local mass effect. No underlying mass lesion is appreciated on the current exam.2.There are multiple microhemorrhages scattered predominantly in subcortical white matter. This pattern could suggest amyloid angiopathy.3.There is siderosis present along the supratentorial brain medially which is suggestive of prior subarachnoid blood.4.MR venogram of the brain is within normal limits. There is no evidence for dural venous sinus or deep vein thrombosis5.Several acute microinfarcts may be present and subcortical white matter of the temporal lobes.6.Periventricular and subcortical white matter lesions of a mild degree are nonspecific. At this age they are most likely vascular related. 