Traumatic hemorrhage of right cerebrum without loss of consciousness, initial encounterClinical question: r/o malformationSigns and Symptoms: hx of ICH There is redemonstration of a hematoma centered in the right basal ganglia measuring 40 x 33 mm axial dimensions. There is associated extension of the hematoma into the right temporal horn of the lateral ventricle. There is intraventricular blood present. There is surrounding T2/FLAIR signal hyperintensity suggestion of vasogenic edema. There is T2/FLAIR signal hyperintensity extends to the right cerebral peduncle, right midbrain and pons. There is some mild mass effect with approximately 2 mm shift of the third ventricle towards the left. There is subtle uncal herniation present.There is a large (25x72mm) area of diffusion restriction involving the right inferior parietal lobule as well as some of the immediately adjacent temporal lobe and precentral gyrus with a second more intense focus of diffusion restriction (47x17mm) extending from the superior aspect of the insular cortex to the centrum semiovale. A third small (15mm) focus of diffusion restriction is present in the right middle frontal gyrus. Little FLAIR signal abnormality is associated with the diffusion restriction.There is loss of signal in the transmedullary veins on the right versus the left hemisphere centered in the MCA territory associated with loss of signal in the cortical veins. There is associated asymmetrically loser signal on SWI in the areas of diffusion restriction.There is a focus of susceptibility effect in the left orbital gyrus.There is a mild to moderate degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.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 opacification of the right maxillary sinus.. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.There is diffuse marrow replacement present which is likely related to chronic disease.
1.There are new foci of cerebral infarction encompassing a significant proportion of the right MCA territory with a larger focus centered in the right inferior parietal lobule but extending to adjacent temporal lobe, another focus centered in the right centrum semiovale and insula, and a smaller focus centered in the right middle frontal gyrus. It is suggested that this is hyperacute and that there is hypoxia in this territory of evolving infarction.2.There is a large hematoma centered in the right basal ganglia associated with vasogenic edema extending to the brainstem and also associated with uncal herniation and midline shift.3.Periventricular and subcortical white matter changes of a mild to moderate degree are nonspecific. They are most likely vascular related. 4.Old small hemorrhage in the right orbital gyrus.5.Findings were discussed with Dr Kramer at around 7:30 pm on 11-4-15