Clinical question: No evidence of intracranial hemorrhage. Signs and symptoms: Status post PEA arrest, intubated weaning sedation. Pre and post enhanced brain MRI:Unremarkable diffusion weighted series.Examination demonstrates a very irregularly shaped focus of heavy in the sitting position in the right basal ganglia extending superiorly and abutting posterior aspect of the body of right lateral ventricle. There is extensive blooming effect and susceptibility MR images. There are small internal foci of T2 hyperintensity throughout the length of this finding and there is evidence of ex vacuo dilatation of right lateral ventricle adjacent to this lesion. Small surrounding FLAIR hyperintensity is also noted with this finding. Examination also demonstrate minimal amount of hemosiderin deposition along the ependymal lining of right lateral ventricle adjacent to this finding. The finding could represent a hemorrhagic infarct in the distribution of right lenticulostriate arteries. Post enhanced images demonstrate enhancement within the center of the lesion using an irregular pattern and without convincing evidence of an associated developmental venous anomaly. Prior head CT examination from 7-27-15 demonstrated a focus of encephalomalacia and with no detectable calcification at this site.Lack of a distinct cavity formation, presence of internal tiny foci of T2 hyperintensity and enhancement within this finding also raises the possibility of a chronic hemorrhagic cavernoma. The lesion is very irregular for precise measurements however the largest dimensions are at approximately 14 x 20 x 20 mm. There is evidence of mild right-sided pulmonary and degeneration best appreciated on axial FLAIR series 601 on images 11 through 17Examination an additional minute demonstrate few primarily periventricular and minimally subcortical foci of FLAIR hyperintensity which are nonspecific, nonhemorrhagic and nonenhancing. Findings are suggestive of mild chronic small vessel ischemic strokes.Unremarkable calvarium, orbits and paranasal sinuses.
1.Negative diffusion weighted series.2.Irregular focus of heavy hemosiderin deposition in the right basal ganglia with internal tiny foci of T2 hyperintensity, internal focus of enhancement, associated ex vacuo dilatation of right lateral ventricle and valerian degeneration and without evidence of calcification on prior head CT as detailed above. The findings could represent a chronic hemorrhagic lacunar infarct however possibility of an underlying chronic hemorrhagic cavernous malformation cannot be entirely excluded.3.Findings suggestive of mild chronic nonhemorrhagic small vessel ischemic strokes is also noted.