Altered mental status, left hemispheric intracerebral hemorrhage. There is a 32 mm x 20 mm sized left frontal intra-axial lesion. The lesions show high signal intensity on T1 as well as T2 weighted image with relatively thin rim of signal voids indicating chronic intra-axial hematoma with hemosiderin ring.There is a another lesion on the left parietal lobe precuneus sized about 4 mm x 19 mm with the surrounding edema. The lesion shows high signal intensity on T1 and low signal intensity on T2-weighted images indicating subacute hematoma.On gradient echo images, there are multifocal gyriform susceptibility lesions on bilateral frontal parietal lobes indicating chronic subarachnoid hemorrhage. In addition, there are small scattered nodular signal voids lesions on bilateral cerebral hemisphere as well as bilateral cerebellar hemisphere indicating chronic petechial hemorrhagic lesions.On gadolinium enhancement, there is no evidence of abnormal enhancing lesion.The ventricles, sulci and cisterns are symmetric and unremarkable. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.3D MRV brain post-gadolinium with maximum intensity projections of the superficial/deep intracranial venous drainage demonstrate normal flow enhancement in the superior sagittal sinus, left transverse sinuses, left sigmoid sinuses, internal cerebral veins, vein of Galen and straight sinus. Right transverse and sigmoid sinus appear to be hypoplastic. There is no evidence of major dural sinus occlusion.
1. Multifocal multi-age intracerebral as well as subarachnoid hemorrhages as described above. In particular, there is a 32 mm x 20 mm sized organize hematoma on the left frontal lobe and 4 mm x 19 mm sized subacute hematoma on the left precuneus.2. No evidence of abnormal enhancement.3. Hypoplastic right transverse and sigmoid sinus as well as right jugular bulb which most likely represent congenital normal variation, otherwise unremarkable MR venogram of the brain.